Patients

Patients

Patients are NOT Customers

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Screen Shot 2015-03-21 at 4.26.26 PMRecently I wrote about the problems with Maintenance of Certification requirements.  One of the phrases I read repeatedly when I was researching the piece was “the patient as customer.”  Here’s a quote from the online journal produced by Accenture, the management consulting company:

Patients are less forgiving of poor service than they once were, and the bar keeps being raised higher because of the continually improving service quality offered by other kinds of companies with whom patients interact—overnight delivery services, online retailers, luxury auto dealerships and more. With these kinds of cross-sector comparisons now the norm, hospitals will have to venture beyond the traditional realm of merely providing world-class medical care. They must put in place the operations and processes to satisfy patients through differentiated experiences that engender greater loyalty. The key is to approach patients as customers, and to design the end-to-end patient experience accordingly.

Except for one thing.  Patients are NOT customers.

The definition of a “customer” is a person or entity that obtains a service or product from another person or entity in exchange for money.  Customers can buy either goods or services.  Health care is classified by the government as a service industry because it provides an intangible thing rather than an actual thing.  If you buy a good, like a car, you voluntarily decide to shop around and get the best car you can for the price.  Even a vacation, especially a vacation package or a cruise, is a good.  A nice dinner, while a good in the sense of the food, is also a service.  You buy the services of the cook and servers.

Here is why the patient shouldn’t be considered a customer, at least not in the business sense.

1. Patients are not on vacation.  They are not in the mindset that they are sitting in the doctors office or the hospital to have a good time.  They are not relaxed, they have not left their troubles temporarily behind them.  They have not bought room service and a massage. They are not in the mood to be happy.  They would rather not be requiring the service they are requesting.  Which leads to number 2:

2. Patients have not chosen to buy the service.  Patients have been forced to seek the service, in most cases.

3. Patients are not paying for the service.  At least not directly.  And they have no idea what the price is anyway.

4. Patients are not buying a product from which they can demand a positive outcome.  Sometimes the result of the service is still illness and/or death.  This does not mean the service provided was not a good one.

5. The patient is not always right.  A patient cannot, or should not, go to a doctor demanding certain things.  They should demand good care, but that care might mean denying the patient what the patient thinks he or she needs.  The doctor is not a servant; she does not have to do everything the patient wants.  She is obligated to do everything the patient needs.

6. Patient satisfaction does not always correlate with the quality of the product.A patient who is given antibiotics for a cold is very satisfied but has gotten poor quality care.  A patient who gets a knee scope for knee pain might also be very satisfied, despite the fact that such surgery has been shown to have little actual benefit in many types of knee pain.

The Patient Expert: Healthcare’s Untapped Workforce

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One of my favorite patient advocates consultants–that’s Kym Martin (far right) on a panel I ran at Health 2.0–has a new job at one of the most interesting patient consultant companies. Here’s her story!–Matthew Holt

Let me ask you two questions.

On a scale of 1 to 10, how would you rate the quality of the “real-world” patient insights your team gathers to inform your mission-critical, life-altering work?

Are you clear on the needs, trends, and challenges facing the patients you’re trying to serve?

Why Listen to Me?

For the past four years, I’ve listened to hundreds of healthcare leaders discuss patient issues from their perspective as clinicians, technologists, researchers, academics and administrators.

While I’m grateful to these leaders for working feverishly on my behalf as a patient, I question the completeness of their patient view.

The reason shouldn’t come as a surprise. Patients are too often left out of the conversations about the services and products designed to improve their care.

Got an Infection? Good Luck Finding an ID Doctor

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Phil LedererBOSTON, Ma. — It was Christmas Day. I was on call at the hospital and was waiting for my wife and 6-week-old son to come so we could eat lunch together. She was bringing kimbap, sweet potatoes, and avocados. But then my pager buzzed.

On the phone was a hospitalist physician.

“Is this ID? We have a new consult for you,” she said. “This man has a history of dementia. For some reason he has a urinary catheter to empty his bladder. We gave him an antibiotic, but now his urine is growing a resistant bacteria.”

I sighed. Yet another catheter associated urinary tract infection.

I walked up the stairs to his hospital room. He was bald, thin, and sitting alone in bed. The peas and fish on his tray were untouched. There were no gifts or tree in his room. I washed my hands, put on gloves and a yellow isolation gown, and introduced myself.

“How are you?”

“Ok, I guess,” he replied.

“Do you know where you are?”

“I’m not sure.”

“You are in the hospital. Do you know what day today is?”

Bridget Duffy: Improving the patient experience

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Bridget Duffy, the CMO of communications tech company Vocera & head of its Experience Innovation Network, is a national leader in the patient experience movement. And we all agree there are lots of improvements needed in the experience for both patients and front line clinicians. Anyone following the story about the death of my friend Jess Jacobs last year knows that there are problems a plenty in how patients are treated (pun intended). Bridget talked with me at HIMSS17 about how well we’ve done and how far we have to go.

Dad Has the Flu and There’s a Baby at Home

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flying cadeuciiAt 6:30 AM, I kissed my 14-week-old son Joe on the forehead and headed off to work at the hospital. By 3 PM I was back in bed with a hacking cough and a fever.  I had influenza.

As a doctor training in infectious diseases, I knew that the flu can be dangerous in vulnerable populations like little babies. I had visions of Joe being admitted to the pediatric intensive care unit, as I swallowed a pill of oseltamivir (brand name “Tamiflu”) and shivered under the covers.

Should I also give my little boy Tamiflu to prevent him from getting sick? The answer should be clear to an infectious disease physician-in-training, right?

I felt competing instincts. Paternal: to “do something” to prevent Joe from getting the flu. Medical: “do nothing,” as the rampant overuse of antibiotics in children has had negative consequences and the same might be true for antivirals.

As I researched the question further, I learned that the decision to give prophylactic Tamiflu is anything but simple.

Close contacts of people with the flu (including babies) can receive Tamiflu if they are at high risk for influenza complications. One Greek study of 13 newborns found that the drug was safe but did not address its effectiveness. Moreover, the number of babies who would need to receive Tamiflu to prevent one serious case of influenza is unknown.

Calcium Scan and Subtractive Medicine

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Being a radiologist, I rarely speak to patients, but I was asked to counsel Mrs. Patel (not her real name, so calm down HIPAA totalitarians), who was worried about the risks of radiation from cardiac calcium CT scan. Because of her risk factors for atherosclerosis, her cardiologist wanted her to take statins for primary prevention, but she was reluctant to start statins. They eventually reached a truce. If she had even a speck of calcium in her coronary arteries she would take statins. If her calcium score was zero she wouldn’t. This type of shared decision making is the most frequent reason why cardiologists order calcium scans at my institution.

Using a Mobile App for Monitoring Post-Operative Quality of Recovery

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flying cadeuciiWhile your correspondent is tantalized by the prospect of healthcare consumers using mHealth apps to lower costs, increase quality and improve care, he wanted to better understand their real-world value propositions.

Are app-empowered patients less likely to use the emergency room?

Do they have a higher survival rate?

Do they have higher levels of satisfaction?

In other words, where’s the beef?

That’s when this paper caught my search engine eye. It’s a report on using an app to monitor post-operative patients at home.

One of Those Patients

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Dr. RobI’ve been getting winded lately.”

He’s a middle-aged man with diabetes.  This kind of thing is a “red flag” on certain patients.  He’s one of those patients.

“When does it happen?” I ask.

“Just when I do things.  If I rest for a few minutes, I feel better.”

Now the red flag is waving vigorously.  It sounds like it could be exertional angina.  In a diabetic, the symptoms of ischemia (the heart not getting enough blood) are atypical.  It’s the pattern of symptoms that is the most important, and to have exertional shortness of breath which goes away with rest is a pattern I don’t like to hear.

What he needs is a stress test – more specifically in his case, a nuclear stress test (because his baseline EKG is abnormal).  But there’s a problem: he has no insurance.  A nuclear stress test will cost thousands of dollars.

I can refer him to the hospital, but I know the financial situation he and his wife face.  They have no money because of a chronic pain problem he has.  He hasn’t worked in several years, but hasn’t ever been able to get disability either (“I tried, but was denied three times”).  Without insurance he’s not able to get his problem fixed, so he’s disabled.  But he can’t get disability, so he can’t get insurance to get his problem fixed and no longer be disabled.

But the problem on hand is this: he needs a test he can’t afford.

There are many folks out there in this same situation.  It may not just be the people with no insurance, and it may not even be people who don’t have money.  In fact, my own family is facing this same problem.  Multiple family members (myself included) need dental work done.  Some need it done badly, yet we don’t yet have the money to pay for it.  So we wait for the money to show up while the problems gets worse.

What If Restaurant Bills Looked Like Hospital Bills?

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You’d get something like this:

hospitalreciept2

HAT TIP: Jeanne Pinder. WHHY Philadelphia. Learn more about Pinder and her project here.

 

What Do Women Know About Obamacare That Men Don’t?

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Susan DentzerFor the second year running, more women than men have signed up for coverage in health insurance marketplaces during open enrollment under the Affordable Care Act. According to the Department of Health and Human Services, enrollment ran 56 percent female, 44 percent male, during last year’s open enrollment season; preliminary data from this year shows enrollment at 55 percent female, 45 percent male – a 10 percentage point difference.

What gives? An HHS spokeswoman says the department can’t explain most of the differential. Females make up about 51 percent of the U.S. population, but there is no real evidence that, prior to ACA implementation, they were disproportionately more likely to be uninsured than men – and in fact, some evidence indicates that they were less likely to be uninsured than males .

What is clear that many women were highly motivated to obtain coverage under the health reform law – most likely because they want it, and need it.

It’s widely accepted that women tend to be highly concerned about health and health care; they use more of it than men, in part due to reproductive services, and make 80 percent of health care decisions for their families . The early evidence also suggests that women who obtained coverage during open enrollment season last year actively used it.