I was talking to a patient a few days ago who was raving about a local grocery store.
”They get it,” she said. ”They understand how to take care of their customers.”
It made me think about how far medicine has drifted away from the same idea. Ironically, despite the fact that our “customers” (people who pay us for our services) are seeking us so we can “take care of” them, we do a lousy job of taking care of our customers. It has been an obsession of mine since I started practice, but it has been something that has been increasingly difficult to accomplish. I now have to fight against the need to meet “meaningful use” criteria so that I can have time to make the record meaningful and useful to my patients. I have to fight against the need to conform to “medical home,” criteria so that I can make my practice the place my patients see as their ultimate medical haven.
The more the government and insurance industries push me toward focusing on my patients, the less time I have for my patients because of the need to meet criteria proving that I am caring for my patients. It’s a mess.
So I went back to my roots. What do I really think should be the rights of my patients? Here is a list that I made:
Patients have the following rights:
The right to have access to care when it’s needed
This does not mean the care is done in the office either. It can be done over the phone or via computer.
The schedule of the office should accommodate the patients’ needs as much as is reasonable to expect.
The right to have care that is convenient
They should not have to wait to be seen or wait on the phone to be heard
They should not have to come in for problems that can be handled at home or work
The right to have a doctor who is not motivated to have sick patients
Having a doctor with the same motivation as the patient: to keep the them healthy
Having a doctor who does not only react to problems, but works to prevent them
The right to get care that is not rushed or distracted
Visits are as long as they take to deal with the problem
Phone calls aren’t cut short from fear of offering “free medicine”
The right to be treated as the one paying for the service of the doctors and their staff
Patients should be satisfied with the “customer experience” in their doctor’s office. They should feel like they spent their money wisely.
They should never feel like a “number” or that the visit revolves around the doctor.
The right to have care that pays attention to cost and does not overdo care
Good care does not mean overdoing it. Good care means offering the care that is best. Sometimes (often) that means doing nothing.
Expensive labs, tests, and drugs should always be considered as to the benefit they offer versus the cost they incur.
The patient should be able to make an informed decision regarding the care they get, increasing their investment in following-through on things.
The right to have access to all of their records at any time
Online access to records is a must. The lab tests do not belong to the doctor and doctors shouldn’t be afraid of the patients seeing them.
The part of the chart (most of it, actually) which the patient knows more than the doctor should be available to edit and control by the patient.
The right to have a doctor who knows what is going on with them
This means that the PCP should always have accurate information about any other care the patient has received. Because of the state of our system, this does put some burden on the patient to communicate with the doctor.
This means that all specialists should know why the patient is being sent.
This means that hospitalists should know what’s going on outside of the hospital and the PCP should know what’s going on in the hospital.
This means the PCP should regularly review patient records to know if care is being missed.
The right to understand their care and not be afraid to ask when they don’t
Every visit should end up with a clear plan.
Preventive services should be clearly understood and spelled out as to when they are due.
The patient should have access to the doctor if confusion arises and get a quick answer to any questions.
No care should be given without a good explanation.
The right to be treated with empathy and respect
Medical professionals should understand that it’s hard to be sick, to have pain, and to die.
The interaction between doctor and patient is a human interaction – the interaction between to flawed individuals. This means an expectation of perfection on either side will only result in bad care.
Patients should never be afraid they are going “to get yelled at” by their doctor. They should feel free to be open when they don’t do the right thing.
The biggest irony is that making this list allows me to meet some of the criteria for “Medical Home,” and future criteria for “Meaningful Use.” Great. Check that off of my list. The problem is that both of these criteria I am working on meeting have a net negative effect on my patients by making me more busy in checking off tasks and reporting data, giving me less time to actually give my patients these rights.
So what do you think about this list? How should doctors work toward patient rights in a setting where we are increasingly burdened with criteria to prove we are meeting them? How can we meet criteria when they themselves are one of the things keeping us from meeting their own goals?
I want to know what my patients want and what they need. My ultimate goal is to meet those needs like the grocery store is doing, offering such good service that when my patients go to the grocery store they brag to the people there about the good care they get from their doctor.
Imagine that.
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If you worry about missing me, I am a pleasure to work with, you might need someone to track your patient base and their utilization so you can set pricing, I can do that for you, minus the check list.
“How should doctors work toward patient rights in a setting where we are increasingly burdened with criteria to prove we are meeting them?”
Eliminate seeking payment from the government and insurance.
Return the PCP and patient relationship to a time when it was between the PCP and patient. I can’t speak for government but as a payor I don’t like all the extra work either. When someone has their hand in my pocket I like to know what they are taking and why. Have patients pay for their PC, either FFS or Capitation, and you can get me out of your life.
Dr Lamberts, why not just say “the customer is always right”?
Saves yourself a lot of needless typing.
“our “customers” (people who pay us for our services) are seeking us so we can “take care of” them”
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Well, for the most part, those are 3rd parties.
And, notwithstanding the vocal chorus of Skin-In-The-Game Theorists, i don’t see that changing materially in the aggregate (not that I disagree with the argument, to a degree — Kleinke has a lot of this right).
More broadly, any “rights” (even the putatively “inalienable” ones) exist as a function of the acknowledgment by and deference of the social order.
You have the “right” in this country to not be left at the ER curbside to die given your lack of finances.
Ron Paul et al would rescind that one (recall the cheers he got for that during a Primary “debate”), among many others.
You have a presumptive 4th Amendment right to privacy (“…secure in their persons…”) — notwithstanding the inane Cognitive Trailer Trash bleatings of Man-Dog Marriage Santorum.
BTW, I am also sympathetic to the observations of commenter Barry Carol. to wit:
“one peculiarity of our present climate is that we care much more about our rights than about our ‘good.’ For previous thinkers about ethics, such as those who wrote the Upanishads, or Confucius, or Plato, or the founders of the Christian tradition, the central concern was the state of one’s soul, meaning some personal state of justice or harmony. Such a state might include resignation and renunciation, or detachment, or obedience, or knowledge, especially self-knowledge.”
– Simon Blackburn. “Being Good: An Introduction to Ethics”
Consider as well the Weeds:
“Patient autonomy does not mean that patients may choose whatever medical care they wish without regard to cost or medical necessity. Patients, providers, and third party payers should not be able to impose medical or financial decisions on each other unilaterally. Checks and balances are needed, including a system for adjudicating disputes. But the standards for adjudication must recognize the patient’s central role. Deference to patient judgment, as distinguished from the judgments of providers or third parties, will lead to more rational decisions. For patients, unlike providers, medical care is an unfortunate necessity, not a source of income and not a career interest to pursue. The patient’s incentive is to obtain the best care BUT NO MORE. And the best care is often not the most expensive care.
This is not to deny that some “professional patients” seek more care than they medically need, due to psychological issues. But such patients are the exception, not the rule. Coping with them requires a system of corrective checks and balances—the same protection we need against dysfunctional behaviors by providers and payers, and the same system we need to guide normal behaviors by all parties. Insurance protection, for example, should enable patients to individually balance cost against benefit in a rational way, protecting them from serious financial harm while still giving them a financial stake, both short-term and long-term, in their own decisions and their own behaviors.” [“Medicine in Denial”, pp 225-6]
That’s quite a list of patient rights. I wonder if you’ve thought about a companion list of patient responsibilities including everything from medication compliance to showing up on time for appointments. Also, how would you define reasonable patient (and family) expectations especially as they relate to an inclination on the part of too many patients and families to sue in the event of a bad outcome and expectations around end of life care?