How can we improve the patient experience?

We’re a disgruntled bunch these days. We think there must be a better way to experience health care.

Doctors say they’re pressed for time, don’t make enough money, have to hassle with insurance companies and typically feel generally burned out about medicine.

Patients feel they wait too long in the waiting room, don’t get much time in the examining room to ask questions or share concerns, want to be more involved in their healthcare but aren’t sure how, and never know how much a drug, procedure or treatment will cost until they get the bill.

Catalyst Healthcare Research wanted to learn more about what we thought about the “patient experience.” So they conducted an online survey of 400 people 52 and older (baby boomers)  in March, 2012. What they found could apply to most people of any age.

Those surveyed said they want:

  • A printed summary of their visit, including their diagnosis and recommended plan of action, before they leave
  • Eye contact with the doctor, and don’t like seeing physicians spend most of their “face time” typing away on the computer keyboard.
  • A reliable estimate of their charges for a recommended surgical procedure
  • An app that allows them to log in and see their test results, send messages to their physician (and presumably get those questions answered)
  • A text or voicemail message if the office is running late
  • Free WiFi in the waiting room
  • Straight talk about personal behaviors that they need to change (like stopping smoking or losing weight)

Personally, I’d add to that:

  • A concise summary of the pros and cons of anything the physician recommends
  • An estimate of the risk associated with doing or not doing what the physician suggests
  • Printed cost sheets for short, medium and extended office visits and any tests or procedures the office provides
  • Acknowledgement of any potential conflict of interest the physician may have in recommending a surgery center, hospital, lab, drug, screening or diagnostic test, or specialist
  • Respect for what I know and what I’d like to know
  • A request for feedback about the visit emailed to me after every appointment

I’m sure physicians have a list of things they’d like from patients. Perhaps if their lists and our lists could be exchanged and understood, we’d all be a lot happier.

What would you say you’d like to see in the “patient experience”?

Barbara Bronson Gray is a nurse who blogs at BodBoss and the Prepared Patient Forum.

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  • rswmd

    “A printed summary of their visit, including their diagnosis and recommended plan of action, before they leave

    Eye contact with the doctor, and don’t like seeing physicians spend most of their “face time” typing away on the computer keyboard.”

    Well, just the first two are incompatible: am I just supposed to think this summary into existence?

    Oh, and make it fast, cheap, and good while you’re at it.

    • http://twitter.com/bbgrayrn bbgrayrn

      I think people want to have something in writing to help them digest and remember what you’ve said to them. But they also want to feel you’ve heard what they’ve told you (via eye contact). I would think that’s doable, no?

      • voitokas

        With a good EMR or for a specialist who can afford a scribe, sure. For a PCP with a crappy EMR, maybe not…

      • southerndoc1

        “I would think that’s doable, no?”
        15 minute visit: 5 minutes for data entry, 2 minutes for MU ( which generates a meaningless boilerplate document that tells the patient nothing), now add on two minutes to create a personalized document that is actually useful to the patient.
        No, it’s not doable.

  • Fred Ickenham

    You have well-described concierge medicine, the only situation in which time pressures and money, and lack of being hassled by third parties allow this. In no other foreseeable circumstance, due to thin profit margins, little time, and defensive tort fears can this nirvana vip care occur.

    • http://twitter.com/bbgrayrn bbgrayrn

      Surely you’re not saying a patient can only get a concise summary of the pros and cons of a proposed medication or procedure under concierge medicine? Or a print out of the take-always from the visit? Or respect for what a patient knows or wants to know? Should we really have to expect to have to pay extra for that?

      • southerndoc1

        If you don’t want to use a concierge practice, you get a fifteen minute visit. If your doctor is using an EMR and MU, half of that time goes to data entry. If you want a printed summary that is anything more than boilerplate, there goes half the remaining time. If the doctor writes a script, another minute to send it electronically, assuming no pre-auth is required. That leaves, what, 4 minutes to deal with probably 3 or 4 problems.
        That’s modern medicine. It’s not about the patient experience. It’s not about the doctor experience. Deal with it.

      • azmd

        Why wouldn’t you have to pay extra? It will take both the physician and the practice extra time to accommodate those needs. Just stop and think about it. When you say you want “respect for what a patient knows or wants to know,” you are suggesting that a thoughtful, and typically prolonged, conversation take place between the doctor and the patient. Such a conversation might be possible within the scope of a 30 minute visit, but those visits don’t exist any more except in concierge medicine, as others here have pointed out. Not happy about that? Feel free to contact your local Congressperson about the need for better regulation of our health insurers.

  • AT

    I could see from the doctor’s end that the requests for them to do more things to appease the patients when the root of many of the suggested problems is lack of time and increased paperwork simply does not make sense. If we want better “service” from the doctors, try helping them out for once.
    Frankly, I agree w/ the responses that the requests listed are quite contradictory logistically and insensible, .e.g. let’s take more time out of the busy doctor’s schedule to constantly update patients on how long they will have to wait while their current patients should get more attention from the doctors. Really?

  • http://www.facebook.com/dill0612 Ken Dillman

    I believe #1 is called “discharge instructions ” and EDs have been doing them for decades.

    • southerndoc1

      And how much does an ER visit cost, and how long does it take?

      • kjindal

        probably averages about 6x what a visit to the primary care internist costs (before medicare automatically downcodes any high-level billing code)

    • kjindal

      at least 30% of all discharge summaries i see from NYC ERs have wrong (even self-contradictory) medication lists or other info. But they are always flush with answers to the common measurable outcomes loved by administrators (“received aspirin?”, “diagnosis of CHF, & given ACE-I?”, “given influenza vaccine?” etc.)
      what a bunch of bullshit.

  • Pointaway

    I would say that they’d better do a better job of choosing whom to survey.
    As long as they’re going to be using very bad EMR software, put a laptop on the patient’s lap and let him or her view the entries as they are being made. Let the patient see what is correct, or misconstured, or, simply does not fit into the system, and cannot be notated where anyone will see it immediately.
    I received a list of medications that I was supposedly taking. It was all wrong. If this had been an emergency, I would have been treated as though I were taking them. I was told the medical assistant would correct the errors. I gave her the correction, and the new list, only added the one actual medication I am taking, but left all the rest. Anyone who isn’t reviewing their transposed medical records is taking a tremendous risk, and, soon, there will be malpractice suits.
    Even before the advent of EMRs, what a patient states to a medical assistant, was often restated to the physician incorrectly, so the patient would have to backtrack again with the physician. And there, gender difficulties persisted, and persist. When this happens with women, it becomes a matter of what women say not having validity. I respect paraprofessionals, but when someone with an advanced degree with a strong history in medicine has to monitor her words because it becomes clear that the assistant does not understand more than very basic vocabularly, there is a huge problem.
    What I want: No EMRs in the exam room. Paper. I want to disrobe so that the medical practitioner will view my body. Much can be determined from looking at skin. These days, one feels one should wear a big “A” , as to make such a request is viewed as perverse. One of the reasons for this is that there are rarely RNs, not even 2-year RNs, let alone baccalaureate level RNs in the exame room, and, heaven knows what a woman will claim occurred, right?
    I want to be told SOMETHING to do. I’d settle for, “Go out and pick apples,” rather than nothing. A warm compress. A cold compress. Sleep. An herbal remedy. Something. Not just be told I’d be hearing from the specialist’s office with an appointment, for example. I’m going to want to make my own appointment anyway. Not just be sent off for many tests, which always seem to include the words, “CT scan,” or “MRI,” or both, and be expected to accept that as the ONLY first line of action?
    I want a follow-up telephone call. I want a call telling me that tests results are normal, if they are. And, if they are – where do we go from here if symptoms persist. A hand laid gently on the forearm. The most remote sense that one is dealing with a “healer.” In lieu of that, let me send my images to a computer, let the computer diagnose and treat me. I would get better care.
    I say, either put up or stop the EMR trade. If you can send photos