Last year, I retired from full-time practice and moved to a new area. At about the same time, my wife was diagnosed with breast cancer, and because she was in good health prior, she had relatively little contact with the health care system as a patient.
Before our move she worked as a part-time school nurse, so we were able to share provider horror stories from different perspectives. Since we moved to a new area, none of the providers knew us, so we went from being providers to consumers of health care.
I also decided to not identify myself as a physician and my wife as a nurse unless asked so we could experience what it’s like to be a typical patient interacting with the health care system.
Although our experience has been good, we could see why many patients are frustrated. The question is, who is to blame? Either health care is as incompetent, greedy and cold, as many believe it is, or health care is trying to adjust to changes that are being imposed from the outside.
Our verdict: 5 percent the former, 95 percent the latter. The vast majority of providers are motivated to try and do the right thing but are being hampered by outside forces that are either well-intentioned but ignorant, or are politically motivated. Couple this with extreme reluctance on the part of providers and their representatives to resist these outside changes and one has to wonder why things are not much worse. Here is a short list of what we have observed:
1. The “we really have no clue why health care costs so much” approach to health care financing and cost. Providers are bearing the brunt of a backlash caused by a third party payor system, including the government, that is both complex and confusing. Very few patients understand the intricacies of insurance, co-pays, and deductibles. They only see that their premiums are going up.
More than once we would be sitting in a waiting area when a patient would yell at the front office staff about their co-pay. The reaction of the other waiting patients would run from “rich doctors” to “greedy insurance companies” to “impeach the president.” I remember one of my wife’s providers almost having a meltdown because she had to tell my wife that she needed a procedure and was worried about the cost and how relieved she was when we told her we had met our deductible.
Next year when the full effect of the ACA hits the average citizens premiums I’m certain the providers will get the blame for that as well.
2. The not ready for prime time EMR push. Especially in the pre-op area, half of the providers time was spent on dealing with entering data into the computer or dealing with software that did not work at all. This took their attention away from true patient care and clearly left them harried.
One day, my wife noticed that her IV had been left wide open and drained out completely. When she pointed it out to them, they nearly went into a panic. Also, there were times when there would be a harried nurse attempting to get my wife ready for surgery and another harried nurse would continually come into our bay begging our nurse to help them with their computer. One way or another it did not look good.
3. The Chicken Little approach to patient safety. Ironically, efforts to improve patient safety have left the impression that providers are incompetent. Every time my wife was handed off to someone else there was a ritual where the person had to check the ID band, ask the patient’s name, the birthdate and what procedure was being done. After about the fourth time this is done is it any wonder that the average patient would question if these people knew what they were doing. The “only the surgeon can verify the surgical site” approach has also slowed things down considerably.
4. The “treat the patient survey, not the patient” approach. Clearly, a poor patient survey has become like kryptonite to health care providers. The smart providers are learning how to play the game because of the supposed link between patient surveys and the push toward quality care. Sometimes the reaction is benign, such as lavish waiting areas, but patient care is clearly being affected.
The push toward simple, streamlined care such as surgicenters and urgent care centers that attract the simplest, and most compliant patients will continue unabated.
From our perspective we noticed that if we did not fill out the patient survey right away we were continually asked to do so. Have the smart providers learned that, left to themselves, a patient is much more likely to complete a “poor” survey then a “good” survey? So by harassing everyone they can up their averages to get as close to the coveted 5-star rating as possible? Perhaps.
These observations are not mutually exclusive and tend to feed on each other. Perhaps the panic over the IV running out was caused by fear of getting a poor review. The panic buying of an inadequate EMR system is the result of a tight budget and resultant desperate fear of not getting any meaningful use money, or worse, an actual cut in Medicare reimbursement.
For whatever reason, from the patients’ perspective, what we are doing is not working.
Thomas D. Guastavino is an orthopedic surgeon.
Image credit: Shutterstock.com
