Article in this month's Journal of Medical Practice Management

If you happen to be a subscriber to the Journal of Medical Practice Management (and there are lots of 'em) you'll find a little article by yours truly in the March/April edition entitled: The 5 Things Patients Want.

Text of the (slightly edited for final printing) article after the jump...

5 Things Patients Want

I write a MedBlog, that is to say: a blog about medical issues, at http://healthyconcerns.com. MedBlogging is an increasingly popular practice, most recently profiled in the Wall Street Journal, but I am, as yet, and anomaly amongst the MedBloggers. I am not a doctor, a nurse, an academic, an administrator, a consultant, a researcher, or even an insurance agent. I am a layperson. I am a patient. And whether the medical profession likes it or not, as a patient, and one who shells out a pretty penny for co-pays and premiums, I consider myself a customer. At HealthyConcerns.com I tell my own stories, and I tell the stories of the people I meet. I like to say that “everyone has a story about health care.” I find it to be too true.

Along the way I’ve gathered a lot of feedback about the kinds of policies and practices I, and other people, would really appreciate when dealing with our health care providers. I hope to share 5 of these pieces of advice, in hopes that those of us on either side of the exam table can get a long just a little bit better…which has got to be good for our health, right?

Frankly I’d rather wait fully clothed, thank you.

#1 – Respect my time too
The number one complaint I have, and that I field from other people, is the lack of respect that medical practitioners seem to show for our time. There’s nothing that can prick the bubble of our self-importance more than waiting for the doctor because it’s abundantly clear that no matter how many dollars I pull in per hour as a consultant, my time is worth nothing to a doctor. Appointment times seem meaningless. You wait in the waiting room. Then it seems like staff thinks you won’t realize you’re still waiting if they put you in the paper gown and let you wait in the examining room. (Frankly I’d rather wait fully clothed, thank you.) Worst of all, sometimes you show up, and the doctor isn’t even there, due to an emergency. Then they flip open the appointment book and want to reschedule you 3 months down the line (as though it was your own fault the appointment had to be canceled.)

It is not the fact that a doctor has to leave for an emergency or runs late because of circumstances beyond their control that is infuriating. It’s that in this age of always-on connectivity, it is mystifying when no one seems to think to contact the patients who will be affected and give them a heads up. You can email me, IM me, text message me, or if you’re not so tech-savvy, you can just call me on one of my 3 phone numbers, starting always with the cell phone. Why do doctors collect all that contact information and then not use it?

The problem really is that all patients are treated as though they were among the troublemakers. Of course I know that there are patients that show up late, and that unfortunate behavior throws off schedules. But do such patients represent the majority? Or are they a troublesome minority that doctors allow to dictate how they treat their entire patient roster? That’s lowest-common-denominator thinking, and it’s not very customer-friendly.

You know what my manicurist does when she’s running late? She calls me and asks me if I can come in 20 minutes later.  Or if a customer shows up just too late, and it’s not an emergency, she defers them to another time. (Laugh, if you like…but most women would consider getting their nails done for their wedding an “emergency situation”, and I would agree!) And, finally, if a client is repeatedly late, she only takes that customer as a drop-in and never gives them a scheduled time again.

Sure, in some cases, it’s not that simple for a doctor…especially depending on the doctor’s specialty. And I’ve seen advice to patients that tells us that we should call to see how the doctor’s schedule is looking before leaving for an appointment. Leave aside that this is placing the burden on the customer (i.e. the person who doesn’t know if there is information that needs to be communicated or not.) No, more importantly, basic tenets of time management indicate that it’s more efficient for medical staff to proactively call patients at a time they choose and set aside, rather than fielding calls from patients all day at random times that the staff can’t control and will therefore regard as interruptions.

The point is that a lot of people in the medical profession tout more “consumer-directed” health care (CDHC) policies as a positive direction for the industry. And that implies more of a partnership between doctors and patients. And partnerships are based on mutual respect. Treating my time a though it has no value at all is one of the most disrespectful thing any “partner” can do.

#2 – Speaking of technology and time management: use it!
According to the latest figures from the U.S. Census, as of 2003, over half of American households are online. And the number has been rising significantly for the last eight years. Not only that, today’s teens are even more active online than older generations. Today’s teens and young adults expect to be able to do just about anything online. When it comes to gathering information, communication, scheduling and other tasks, there is actually no reason why they shouldn’t expect that! The tools exist. It’s time to leverage that fact and bring medical facilities into the 21st Century.

Obviously I’m a big advocate of using technology, particular mobile applications, to contact patients and let them know about the day’s schedule issues. But let’s take it further. There are pretty ubiquitous online scheduling applications available…why not allow patients to schedule, change or cancel appointments online? Set up parameters. Set up permission levels. And sure, remove permissions for any patient who abuses the system. Again, you might find that the majority of your patients are reliable and truthful and don’t deserve to be treated the same as the few bad acters out there in your file cabinet.

You’d buy a lot of patient patience with such a system!

Further, why not let us submit our questions online, rather than leaving messages with services? You’ll get to hear the question in our own words. We could rank the priority level of our request. You could even have staff do a sanity check on the priority levels. Best of all, doctors could implement a trackable system that allows patients to see the status of their request. (Think tracking a FedEx package online.) What gets peoples’ goats is silence. The feeling that our questions and needs are lost in some black hole of bureaucracy.  Even being able to go online and see that our question is in a queue lets us know that it has been received and will be addressed. Many consumer companies use such systems for customer service requests or for bug tracking. You’d buy a lot of patient patience with such a system!

Lastly, consider using technology to print out your prescriptions and other instructions. I know, I know, the handwriting of doctors is a long-time source of humor, but it’s time to let it go. It’s no longer funny when you’re the one who gets an incorrect prescription or can’t figure out what you’re supposed to do.

#3 – Your 1000th suspicious test result is my 1st one
I have had a couple of minor scares in my medical past…one abnormal pap smear and one “shadow” on my mammogram. In such a situation I don’t think I am alone in immediately fearing the worst-case scenario. Abnormal pap=cancer. Mammogram shadow=cancer. It’s about that simple of an equation. It’s human nature to imagine the worst. Imagining the worst is scary. Being scared is not conducive to clear rational decision-making. Another simple equation.

As it turns out, what my abnormal pap might have indicated was Pelvic Inflammatory Disease, not cancer. The cells were not consistent with potentially cancerous cells. But I didn’t find that out until 3 weeks later, after I’d picked up a prescription, taken it for a couple weeks and then gone in to take a 2nd pap smear. The doctor who called, gave me my initial results and gave me instructions didn’t think to mention that it was probably not cancer. Consequently I of course assumed it was cancer. I consider those three weeks of heavily increased stress completely unnecessary.

Likewise, I got the word there was something amiss on my mammogram from an appointment scheduler with the radiologist. (To her credit, she was mortified that I was first hearing there was a problem from her.) After I finally got a call-back from my doctor (after leaving two messages over two days) the doctor launched into a somewhat annoyed-sounding litany of worst-case scenarios. She made it sound like the best-case scenario was that it was a cyst that would have to be aspirated. What she never mentioned was that a) it could actually be nothing, merely an indication that the technician hadn’t sufficiently squished my breast to get a good film or that b) it could be a slightly denser portion of breast tissue that should be watched, but wasn’t necessarily either cancer or a cyst. Perhaps she figured that was obvious. But I spent a couple of weeks, again, convinced there was something definitely wrong…when there wasn’t.

#4 – Treat me like an intelligent adult and give me the details
Now, all of the advice in Item #3 was not to advise doctors to sugar-coat things. Far from it. Most patients want their doctors to talk to us like adults. To tell us what they’re doing and why. To tell us all the possible outcomes and the likelihoods of those outcomes. (Just remember to include the most innocuous, least serious outcomes on the list!)

The age of doctors being regarded as infallible father figures is gone. You can blame TV. You can blame politics. You can blame the 24-hour news cycle. Or maybe you won’t blame anyone, because you think it’s a good thing (back to the CDHC concept.)

Point being: it’s increasingly likely that we, your patients, will want more detail than we used to. (Probably because we’re going to go look everything up online, truth be told.) Use this as the boon it really is. We’re better informed. We can make better decisions. We can be better advocates for ourselves. So, here’s what we want:

-Listen to our questions.
-Take the time to answer our questions.
-Don’t roll your eyes if we got them by researching online.
-Spell things so we can have an easier time looking them up later.
-Hey, I bet you use some online resources too…how about giving us the URLs?

Hypochondriacs will be hypochondriacs, and I bet the Internet is like a big candy store to them.

When my cat (bear with me) was diagnosed with feline lymphoma one of the first online resources I found was an academic presentation that was given to veterinarians. Yes, much of it was over my head. But it gave me a great starting point for my research. And better yet, being able to find a wealth of online resources addressing my specific problem calmed me down. I found information. It made the problem less mysterious. And best of all I even found online support groups comprised of people with the same problem.

Hypochondriacs will be hypochondriacs, and I bet the Internet is like a big candy store to them. Most of us are not hypochondriacs, though, so, appreciate the great resource that the Internet is and work with us to help us make the most of that tool.

#5 – Treat adults like adults, but treat kids like kids
I’m not a parent, but I thought I’d better check with one before finalizing my list, just to make sure I didn’t miss anything. I’m really glad I did. When I asked my friend she immediately came out with something I never would have thought of…because I never would have thought doctors did this. But here, I’ll let her tell you, “When it comes to something to do with my kid’s health, don’t share all that great detail about best and worst case outcomes with me and my kid, together, for the first time. Tell me first…then let’s decide what to tell my child.” I mean, my friend’s nine-year-old is a mature little dude, but there is some stuff he doesn’t need to hear. Not only that, he doesn’t need to see his mom’s reaction to hearing some of that stuff for the first time, unfiltered. She also brought up that the same could potentially go for one’s elderly parents if they were suffering from Alzheimer’s or some other form of dementia.

It might sound like, from my list, that doctors are in a no-win situation.

Take the time. But don’t keep me waiting.

I want all the possible outcomes. But I don’t want to be unduly scared.

Tell me everything. But don’t tell everyone everything.

Really, all we, your patients, your customers, your partners, are looking for is a little more thought to go into what happens before the doctor ever opens his or her mouth in the exam room. A little more organization to respect our time. A little more consideration that we may be just one of many patients to you, one of many similar cases you’ve dealt with over the years. But it’s a first for us.

Comments

[Flea]

PID ain't no stroll in the park, sugar!

Much as you may already hate me, I hope you'll be happy to here that I'm pretty much down with all five of your criteria.

I almost never make parents wait. And I apologize when I do.

I use electronic communication heavily, though (interestingly to me) the parents under-use it.

I give lots of details. It's typical that I'll answer three questions in addition to the question that is actually asked.

I talk to the kids as kids. I speak their language. That language, BTW, is not baby talk.

best,

Flea

[Elisa Camahort]

Hate you? Not at all!

I know plenty of doctor's offices are getting with the program. Kaiser is actually pretty good about the electronic stuff.