12 Questions Empowered Patients Should Ask When Looking For A New Physician…Are You Ready?

Conventional wisdom tells people that when looking for a new physician they need to consider things like Specialty, Board Certification, years in practice and geographic proximity.   Online services like Health Grades allow you to see compare the satisfaction scores for prospective physician candidates.

But industry insiders know different.  Consider those patient satisfaction scores for physicians.   In reality, “one can assume that the quality of care is actually worse than surveys of patient satisfaction would seem to show,” according to a 1991 lecture by the sage Avedis Donabedian, MD.

“Often patients are, in fact, overly patient; they put up with unnecessary discomforts and grant their doctors the benefit of every doubt, until deficiencies in care are too manifest to be overlooked.”

Given the constant drumbeat about the lack of care coordination and medical errors, it would seem that that some people (patients) are beginning to reach that breaking point alluded to by Dr. Donabedian.   The empowered among us are starting to compare physicians (and the hospitals that own employ them) to a higher standard.  A higher standard that reflects the nature and quality of the medical services physicians actually provide.

Empowered patients today are “being taught to be less patient, more critical, and more assertive.”  In Donbedian’s own words, “patients are justified…in suspecting that the practitioner who has been cursory, inattentive, uninformative, or even rude has not marshaled the full potential of technical skills on their behalf. “

So how might an empowered health consumer go about finding a new physician these days?

Here’s a list of 12 evidence-based questions that every patient should ask prospective physicians: How would you describe your communication style? How do you inform patients of lab test results? How long after you get your lab results before I can expect to be notified? What percent of your adult patients have had their recommended preventive screenings? Will you take the time to understand and respect my beliefs and opinions about my health and communication preferences? What percent of your patients are non-compliant with respect to taking their medications or otherwise following treatment recommendations? If I need to hospitalized, who would my doctor be? You or some hospitalist? What safeguards do you have in place to prevent communication hand-off errors should I be hospitalized or seen in the ER? How do you feel about my bringing a friend or spouse to my visit? Do you encourage patients to ask you about health information they have found on the Internet? For patients needing additional information, do you have a list of recommend websites you can give me? Will I get a written post visit report summarizing what occurred at each office visit, including medication and self care instructions? Original work of the author – Steve Wilkins MPH

So if you are a self-satisfied hospital administrator patting yourself on the back because of your high patient satisfaction scores (with your physician-owned practices) watch out.  There are hospitals and physicians across town that “get” what empowered health consumers want…and one day soon they are probably going to eat your lunch.

Source:

Donabedian, A., Quality assurance in health care: consumers’ role.  The Lichfield Lecture. Quality in Health Care 1992;1:247-251

Why Can’t Physicians Be More Like Dentists When It Comes To Patient Follow-up?

I have to give my dentist credit.  He and his staff know when I am due for a cleaning and call me to schedule an appointment without fail.  They also call to remind me the day before an appointment.  Many dentists, I understand, do similar kinds of things for their patients.

As a patient, I like being reminded…it is a great service. I also like the fact that someone’s looking out for me.  From a business perspective it makes a lot of sense as well.  Fewer “no shows,” more cleanings, more billings, and so on.

It’s too bad that more physicians don’t routinely follow-up with their patients, particularly when it really counts.

Take the example of 172 patients in a 2008 study by Maniaci et al. of patients discharged from the hospital with a new medication.  Within 3 days of discharge, patients were surveyed about what they “knew” about their new medication based upon what their attending physician told them.

According to the study:

• 36% of patients did not know the name of the medication they were given
• 36% of patients did not know what the new medication was supposed to do
• 44% did not know the proper dosage instructions for the new medication

If this is representative of the quality of physician discharge instructions at most hospitals, is it any wonder that 20% of Medicare hospital discharges end up being re-admitted to the hospital within 30 days….and 34% after 90 days post discharge?

Remember that medical errors are a frequent cause of action in malpractice cases.  Poor physician-patient communications at time of discharge about new medications, follow-up tests, follow-up with their primary care physician, etc. are examples of common medical errors.

In a similar study, Kripalani et al., found that almost 50% of patients sent home with a new medication experienced some degree of medication non-adherence in the 2 weeks following hospital discharge.  When patients in the study were asked what could be done to improve medication use almost 70% said a follow-up phone call to review medication would be helpful.

Why can’t physicians be more like dentists when it comes to proactively following up with patients?

Sources:

Maniaci et al. Functional Health Literacy and Understanding of Medications at Discharge.  Mayo Clinic Proceedings. 2008.

Kripalani et al. Medication Use Among Inner-City Patients After Hospital Discharge: Patient-Reported Barriers and Solutions.  Mayo Clinic Proceedings. 2008.