[tweetmeme source=”Healthmessaging” only_single=false]Health care professionals are a cynical lot. We joke about the “fad or buzz word of the month”…usually some vague concept heralded by the powers on high. Our job is to promote the idea…knowing full well that the “next big thing” is probably right around the corner.
Take “Patient-Centered”…it sure feels like a buzz word. I suspect most hospital and physician executives, and their ad agency partners, would agree. But this time things are very different.
Why Hospitals and Physicians Should Get Serious About Patient-Centered Care
Reason #1 – Patients Are Starting To Discover That Their Doctors & Hospitals Are Not Nearly As Good As They Should Be
Little Toto pulling the curtain back on the great and powerful Oz
“Pay no attention to that man behind the curtain.” This line comes from the Wizard of Oz where little Toto (the dog, duh) rips the curtain back to show the great and powerful Oz is merely an old medicine show marketer from Kansas. (Ouch).
The analogy is a good one. Patients across the U.S., and other countries, are “doing a Toto” as they pull back the curtains on doctors and hospitals only to learn that they are often not getting the quality of care they expected.
People every day hear about some story that undermines their confidence in the health care system. Doctor Smith at XYZ hospital amputated the wrong limb again, Sally down the street was given the wrong medication, Mr. Patel’s opinion was ignored by his doctor, and so on. Unlike years past when such stories were infrequent and seemed to occur in some other city… stories now appear daily, occur in my city, and are instantly shared with people around the world via the internet.
Reason #2 – Patient-Centered Care Is The Right Thing To Do…Plus It’s Not That Hard
I think most would agree that today’s health care system is still very provider-driven. That means that the care that is delivered, how it is delivered, who delivers it, and how outcomes are measured are all defined from the providers’ perspective (physicians, hospitals and payers ). Patient-centered care simply means looking at these same issues but from the perspective of individual patients. Notice nowhere here did I equate patient-centered care with smile training, customer service training or pianos in attractive lobbies. Patient-centered care means involving patients in the planning, delivery and evaluation of health care where it really counts in terms of outcomes, patient adherence, cost reduction and fewer re-hospitalizations.
Being patient-centered is like doing a market research study and then implementing the findings. Patient-centered care does not give absolute control to patients…it simply invites them into the party and gives them a place at the table. As providers, we don’t do a good job of listening to patients. We do an even worse job when it comes to acting on what patients tell us they want.
Reason #3 – Patient-Centered Care Will Make Any Hospital Or Doctor Stand Out From The Crowd
Like a beautiful rainbow, patients and providers will recognize patient-centered care when they see it. Like rainbows, example of patient-centered care are few and far between…but here are some tell-tale signs:
- Providers and patients know each others’ names
- Patients’ opinions are actively sought, listened to and honored where possible (and no, having a suggestion box, patient satisfaction survey or mission statement do not constitute being patient-centered – if you think they are then you aren’t patient-centered).
- Patients tell you that their doctors and other team members really listened to what they had to say (again if you think satisfaction surveys qualify you aren’t there yet).
- Patients are treated as the most important member of their health care team and taught how they can best contribute to the team’s success.
- Providers feel that their patients are actively involved in their own care.
- You see a significant improvement in patient health status, adherence, engagement, level of utilization and patient/provider experience.
If these aren’t good enough reasons to give Patient Centered Care another look at your organization then just think about this. Beginning in 2013, 30% of hospital Medicare reimburse will be determined based upon patient experience. Eventually commercial payers will follow suit.
As more patients “do a Toto” on your doctors, hospitals and other providers, are you ready for what they will find?
Mind The Gap 
I consider myself an empowered patient, meaning that I take care of my end of the appointment and expect to be treated with respect. However, if my expectations are not met, my only recourse, as I see it, is to go elsewhere, because expressing dissatisfaction is a sure ticket to a “termination” letter, certified mail, by the end of the week.
Who are these people across the nation and HOW are they expressing their dissatisfaction? Does complaining on a blog post translate into change at the doctor’s office? I don’t think so.
Just how does one “do a Toto” in a meaningful way? How do I, as an individual, “pull back the curtain” without getting “fired” in the process?
Abby,
Great question. I have learned through the school of hard knocks that you can disagree with someone without being disagreeable. As such, “Doing a Toto” does not mean you have to confront your physician so much as it means that you challenge your physician with facts. Recently I learned that half of my siblings were diagnosed with Celiac disease. Because it is hereditary, I asked my physician about getting screened as well. He laughed and said I did not look like I had a problem “absorbing nutrition from food.” (Real funny). Later I shared a copy of a research study with him and expressed my concerns about intestinal cancer. My doctor authorized the test for Celiac disease.
If your relationship with your physician is such that you fear “being fired” for advocating for your own health, you have a problems. Your physician does not respect you or your opinion and I suspect you have some trust issues with your doc. Life’s too short and there are too good physicians out there to waste your time on a bad one. But before you leave, tell the doctor why you are leaving and that your will be sharing your experience with your 5,000 Twitter followers and 10,000 Facebook fans.
Hope this helps.
Steve Wilkins
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According to the AAFP model of the Patient Centered Medical Home, patient-centered means:
1. Administrative chores take precedence over patient care
2. Doctors have larger patient panels to care for
3. Appointments are shorter
4. Patient’s access to her physician becomes more limited.
When the disastrous results of the National Demonstration Project came back, showing significant decreases in patient satisfaction, they added PEAT (Patient Experience Assessment Tool, I think): i.e., a patient survey!
I don’t think that is going to fix the problem.
Southern Doc,
I saw the published papers on the TransforMED National Demonstration and know exactly what you are referring to. I attended a PCMH summit last month where Dr. McGinney presented on the medical home model. One of the things that I believe helps explain the down turn in patient satisfaction you noted was the fact that the demonstration sites were trying to meet certification standards at the same time as they implemented EMR systems. In other words they overwhelmed themselves and their patients over the course of the transformation. I also suspect that they didn’t do a very good job communication with patients about 1)the transition itself or 2) all the new expectations and responsibilities that patients were assigned as a result of the transition. I understand that it is not uncommon for patients to initially resist taking on tasks which once were the doctor’s job.(from the patient’s perspective).
Having said that, I would tell you that the literature is full of primary care practices that have made a much smoother transition to the PCMH model through incremental reforms. Thousands of small practices (2-3 docs) in Michigan for example have become certified and are now receiving incentive payments…and apparently doing very well. Initially the focus is mostly about checking off the boxes on the path to certification. But expect some PCMHs to make the transition to the kinds of meaningful changes in patient-centered care which everyone would like to see. That’s my 2 cents.
Steve Wilkins
“Thousands of small practices (2-3 docs) in Michigan for example have become certified and are now receiving incentive payments . . . ”
Actually, that is the point that I was making: the PCMH is all about administrative work and payment. Read the guidelines: there’s nothing in there about better patient experience or better health outcomes.
Patients in the NDP made it clear that they don’t like offices where administrative chores are more highly valued than patient care. The staff at Transformed has tied themselves in knots trying to explain away these results. Spreading a bad two year experience out into three or five years still won’t make it a good experience! As a patient, how many years of unsatisfactory experience would you put up with so your doctor can become certified?
And please don’t look to Transformed for an objective evaluation of the strengths and weaknesses of the PCMH. They make their living by selling it!
Southern Doc,
I get your point. I agree with you. Like you, my concern is that it is too easy for practices to “check off the boxes” on NCQA criteria check list and collect more reimbursement without making any real changes in how care is delivered. Just look at the PCMH certification used by NCQA. It addresses administrative structure and process measures such as you suggest. I suspect – or hope anyway – that with PCMH 2.0, we will actually start seeing more emphasis on patient-centered care, including communications, and less on the trappings like EMS and embedded care managers.
Sounds like you have had some experience on this subject.
Steve Wilkins
Well said.
My experience with the PCMH is to stay as far away from it for as long as possible! There are parts of it that are good and that I already use, but the overwhelming administrative burden of the full-certified PCMH would not benefit my patients, my staff, or me.
Sadly, the AAFP is attempting to force this rigid, patient-unfriendly form of practice management on their entire membership. Lots of us aren’t buying it.
Sadly this article and the list are all to obvious to everyone except those people making the decisions>
That’s not to denigrate this article because it is excellent, but perhaps it is talking to the converted.
Hogwash. I couldn’t disagree with the sentiment of this article more. The overall improvement of healthcare provided by hard working physicians is being completely overlooked by this kind of poisonous rhetoric. Primary care providers across the country have been operating as “Patient Centered Medical Homes” long before any bureaucracy coined the term.
Rocco,
Thanks for your comment. While you are entitled to your own opinion, you are not entitled to make up your own facts. Of course there are lots of hard working physicians practicing patient-centered care, whether certified as a PCMH or not. Do they get the credit they deserve….probably not. But the vast majority of physicians, according to published research, still employ a decidedly physician-directed style of communication with patients. According to this research, the benefits of patient-centered care (and communication) in terms of better outcomes, adherence, lower costs, higher patient and physician satisfaction, simply do not support your argument.
Steve Wilkins
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Mr. Wilkins,
I enjoyed your article very much and couldn’t agree more. I am a physician, trained as a general internist, though I’ve worked as a hospitalist for the past 11 years. You point out a number of things that need fixing with our current healthcare delivery system. The very thoughtful replies have added to and enriched the conversation. But I think it’s impossible to fix the whole thing at once, to attack all the problems simultaneously. If I could do just one thing, I would have doctors listen, really listen. To patients, families, nurses, anyone who deserves their attention. I’ve come to realize how important listening is, not just to make patients feel good, but for a number of practical reasons. Most doctors, I fear, think of listening as something you do as little of as possible, just until you’ve made up your mind what the patient has and what the doc is going to do about it. Beyond that it becomes a passive exercise, essentially a waste of time.
But real listening, in the healthcare setting, is anything but a waste. Listening – real, engaged listening – is an active exercise. It is, or can be, therapeutic. It engenders trust, breaks down barriers, reassures, improves compliance and really empowers patients.
I haven’t done a survey, but I’ll bet that the single most frustrating – and frightening – thing about being a patient in a hospital is the loss of control which is directly related to the loss of one’s voice. And a patient doesn’t have to have laryngitis to be voiceless in a hospital.
You are right to say that patient centered care is the right thing to do, and it’s not that hard. I learned about this listening thing in, well, less than 30 years (or maybe it took me that long to UNlearn a few things…)
If you’ve made it this far, thanks for listening.
JD Wright MD
Excellent article. I myself found myself wishing I could find a doctor that would respect me and my wishes. I have only found one or two doctors in during my life that could accomplish this. It seems like doctors would rather be working on automobiles rather than people so they would not have to deal with the emotional aspect of the patient. I recently had a none life threatening traumatic experience dealing with anesthesia awareness that resulted in some short term PTSD, at a Utah medical school. What I dont get is that from the very moment that it became apparent that I was having problems my doctor absolutely refused to talk to me about it and even told me he only wanted to talk about heart isssues. He did not even make a suggestion to seek out care for this issue. So I basically had to diagnose myself in a very compromised emotional state. Needless to say, this doctor patient relationship devolved very quickly.
Frankly I think the answer to these problems is a simple supply and demand problem. I say open many more medical school facilities, let all those Cuban doctors come over. When there is no competition there will never be good service or care.
KTY,
Thanks for your kind words and thanks for sharing your story.
Steve Wilkins