- Patient Experience: The biggest thing shaping patient experience is that patient experience now matters, due to satisfaction scores and financial penalties among the largest drivers.
- The Affordable Care Act: Insurance coverage expansion for millions of Americans, particularly those with pre-existing conditions has provided new opportunities for patients to seek care, but the ACA still faces challenges from a newly empowered GOP Congress and Supreme Court cases.
- Electronic Health Records Adoption: More doctors’ offices and hospitals have implemented their EHRs and are learning to use them, offering patients fewer opportunities to give the same demographic information over and over again, although multiple portal sign ins may fill the time.
- Access to Data: The number of pledgee organizations to the ONC’s Blue Button program continues to grow and Meaningful Use requirements that patients have the right to view, download, and transmit their data improves access to medical records and claims data.
- Contributing to Data: Whether you wear a wearable activity tracker on your bracelet, belt, or bra, patient generated health data (PGHD) is expanding the scope of what is considered health data by quantifying the 99% of our lives spent outside the doctor’s office.
- Framework for Big Data: Lots of “little” PGHD quickly becomes Big Data with the potential to revolutionize research, creating an active, adaptive learning health system once there is greater consensus on issues of privacy, security, and consent.
- Personalized Medicine: The realization that Big Data and genomic-based medicine are interdependent, each needed to facilitate personalized treatment delivering precision therapeutics trained on biomarkers and individualized care based on analytics.
- Defining interoperability: All this data stays data, rather than knowledge, and actionable information unless it allows care to be connected seamlessly, following the patient in a physician and practice-agnostic manner rather than captured in hospital system silos.
- Telemedicine and Retail Clinics: Bringing care to the patients whether around the corner at the drugstore, an urgent clinic, or through video consult, provides substance to concepts like access and convenience.
- Cost information: The advent of higher co-pays, deductibles, directly paid premiums, and shifts in the conversation to value in healthcare creates the demand for transparency in the cost and price of tests, procedures, and services.
- Expanding roles of nurses, PAs, NPs: As the medical complexity of patients, as well as the recognition of the behavioral, literacy, and other challenges creating barriers to patients co-developing, understanding, and implementing prevention and care plans and achieving goals for which medical practices are accountable, the role of non-physician clinicians will continue to expand.
- Online Patient Platforms: Online platforms and communities provide 24/7 information, support, and experience comparisons heretofore found only approximated in live support groups or phone hotlines.
- Research & Drug Development: Patient advocacy organizations are taking a more proactive role in developing research agenda, pulling together research consortia, funding targeted drug development through venture philanthropy models, and redefining risk/benefit and other determinants of the drug approval process.
- The Patient Voice: New positions in federal agencies, on medical boards and committees, and in hospital councils mark the transition from patients simply having a voice, but having a vote in essential matters shaping healthcare.
- Relationship with Doctors: The doctor-patient relationship is stressed, stretched, and frayed by all of the above, but more important than ever for the integration of scientific, clinical, and social information into expert counsel, deft surgical technique, and partnership in healing.
Posts Tagged ‘doctor’
Three things neatly intersected to compel me to write this blog post:
- Reading How Doctor’s Think by Jerome Groopman which I strongly urge every patient to read and then send copies to all your physicians to create the most productive healthcare partnerships.
- Time spent with the leadership of the American College of Physicians Foundation. The ACP is a founding member of the Patient-Centered Medical Home initiative and is very thoughtful about how physician practices can better serve patient needs and improve outcomes.
- Preparing to be interviewed for the Chaos Solutions Blog Talk Radio show, my 1st foray into this medium. http://www.blogtalkradio.com/chaossolutions
Far from being a nerve-wracking event I believe that visits to the doctor’s office can be an empowering experience and an essential step to living the fullest, healthiest life possible.
My recommendations involve the 3 O’s – Observe, Organize, and Obtain.
- Observe yourself for at least a week (women perhaps a month or whole menstrual cycle) before your visit.
- What are you eating and how is your body reacting?
- How are you sleeping?
- Do you get out of breathe going up the stairs?
- Do you have swelling or other body changes?
These are all important to note and bring into the conversation with your doctor.
2. Organize, Organize, Organize
- Bring a list of all your medications, with names (brand and generic) dosages. Include vitamins, supplements, and herbs.
- Bring a list of all your doctors and complementary medicine specialists as well
- Bring a full medical history (don’t rely on your memory for what year for which surgery and the results)
- Bring a family medical history
- Create a list of your key questions and concerns
- DO NOT LEAVE without instructions and prescriptions for any new medications
- DO NOT LEAVE without test slips, referral forms, and directions ( fasting, other prep)
- DO NOT LEAVE without a nurse or other number to call if you have questions
Become an engaged, empowered patient and make the most of your doctor’s visits!
As part of an otherwise excellent presentation on the key drivers of rising healthcare costs, two slides purported to demonstrate that overbuilding of healthcare facilities was the result of inappropriate emphasis by patients on facilities’ cleanliness and convenience as measurements of quality. The presenter’s point was that patients could not be trusted to assess healthcare quality since they chose such obviously silly metrics instead of judging and selecting hospitals or physician practices on the basis of cost, outcomes, or adherence to guidelines.
I had several thoughts in reaction, a few of which I can print – (1) With upwards of 2 million nosocomial (my favorite word) infections a year causing more that 100,000 deaths and complications, cleanliness is nothing to sneeze at; (2) in a past life I was taken to task by the HRSA administrator for making the point that there might be value in having the choice of a transplant center close enough that families could support their loved one through a traumatic life event so I won’t comment here on the issue of proximity; but most importantly (3) patients judge what they can see. If we make quality metrics such as cost, outcomes, and adherence to guidelines more accessible to patients then they will include those metrics in their decisionmaking.
And so I embarked on my own journey to see how readily available patient-friendly quality data is for patients. First I looked for information on hospital information. Hospital Compare http://www.hospitalcompare.hhs.gov/, an HHS website powered by Medicare data, allowed me to compare hospitals within a radius of my chosen zipcode on process of care (basically guidelines/evidence) adherence, outcomes like death, and patient satisfaction elements like physician communication or nurse responsiveness. Interestingly, among the subset of local hospitals I chose, quality was similar but median Medicare payment ranged from a two to four fold difference. Still a limited set of procedures and conditions are included, I have no idea how patients with my demographics and characteristics fared, and the Medicare cost data may bear little relation to what I might actually pay under my insurance let alone self-pay.
Physician information is available in a variety of formats for various fees, typically $9.95 to $24.95 on websites such as HealthGrades http://www.healthgrades.com and Physician Reports http://www.physicianreports.com or compiled in the Consumer’s Checkbook Guide to Top Doctors or Castle Connolly’s various city-specific Top Doctors. Plugging in one of my specialist’s name I was able to get disciplinary actions (luckily none), board certifications, years of education, hospital affiliations and even ease of scheduling, however I had no idea from the information provided if my doctor was any good.
Lastly my health insurer has a premium designation that awards stars for quality and cost-efficiency. I could not find the basis for those designations and having been ill-served by one of their “centers of excellence” in a particular specialty, you can color me skeptical.
My takeaway is that even for a highly motivated, insured, internet savvy patient, with fair familiarity with health care and health care jargon, comprehensive actionable physician and facility information is limited, hard to find or non-existent.
As the costs to the pharmaceutical industry and to the economy from patients not taking their medications as prescribed escalate into the billions and physician reimbursement is increasingly shifted to a “pay for performance” model where they are judged by outcomes as well as interventions, interest in understanding why patients do and do not comply with medication or other therapy recommendations increases.
Surveys of physicians consistently report a top complaint that patients refuse to take their medications as directed. Surveys of patients just as consistently state patients’ views that they are fully compliant with their medication therapeutic regimen. Somewhere in between lies the truth.
First, there’s the term compliance. Compliance, as defined by the Random House Unabridged Dictionary, is the act of conforming, acquiescing, or yielding. A person does not trade her free will for blind obedience when she trades her clothes for a paper gown. In this age of personalized medicine patients demand and deserve a personalized plan on taking that medication to which they are empowered and inspired to adhere.
Second, when a physician asks if a patient has taken her medicine that seems like a yes or no question. In fact, the patient is being asked, “Did you fill the prescription in a timely manner? Did you take the right dose at the right time in the right way every time (with food without food with a full glass of water on an empty stomach without lying back down for 30 minutes)? Did you take all the medicine (even after you felt better)? And did you refill the prescription as soon as you finished the first?” A patient may answer yes if they have fulfilled even one of these criteria.
What would drive a patient, even if diagnosed with diabetes, heart disease, or another serious, life-compromising condition, to not follow “doctor’s orders”?
- Didn’t like being ordered around by the doctor
- Medication tastes bad Side effects too much to bear
- Method of administration painful or unpleasant
- Taking the medication reminds the patient of her mortality
- Doesn’t believe the condition is that serious
- Treatment interferes with lifestyle
(To be continued in Part II)