For the medical home to be successful, listen to the patients

Standing in the middle of a massive hotel convention center hallway with thousands of people wearing name tags.

Not where I usually spend my days.

I have been asked to join senior management at a national client conference for the company that is providing patient survey data to our institution, those surveys patients get in the mail asking about their “experience” during their visit to our practice.

Everybody here wants the same thing, everybody here wants to make things better. Everyone has a different agenda, and everyone has a different idea how to get things done.

Massive, earth-changing ideas focused around transformational care, thought leaders from the world of health care challenging us with ideas on how to remake the system locally, nationally, globally.

Individuals from small practice administrators to front-line workers, sent to bring a little bit of change back to their home, a small idea hoping to improve the lives of their patients, their staff, their clinicians, and hopefully alleviate some of the suffering created by our system along the way.

A new way to collect patient data, a new way to present patient data, a new way to report, the next big thing. This is going be the thing, it’s going to get us where we want to go, this is the system of information management that will give us what we all really need. Is this, could this be, the wave of the future?

When the national leaders speak, we all listen, at rapt attention. When the rock stars of the health care industry and political superstars and reality television stars talk, we stand and cheer. When the presenters at the smaller booths talk we listen, trying to figure out how this fits into our lives, trying to figure out if this is that one thing that’s going to be the game changer.

Handouts, PowePoint presentations, glossy magazines, kiosks, slick presentations by well-trained presenters, salesmen masquerading as members of our team.

I know we all need this, we need good hard data to lead to change, I know this is trying to do some good. We recognize that it is hard doing our job, and none of us is intentionally ignoring our patients and their needs, leaving unfulfilled their desires for achieving perfect health.

And when we get those “report cards” showing our low numbers, we all think, this is somehow a reflection on me, it’s personal, there must be something wrong with the data, this can’t be what my practice is really like, this cannot be what I am like as a provider.

For our patient-centered medical home to truly be patient centered, we need to hear the voices of our patients, to listen and learn from their experiences moving through our practice. Any change needs data to help us evaluate that change. Did we really make things better? Did we accomplish what we set out to do? We can think that any change is a good change, but hopefully we have learned that this is not always true. And just getting more data is not the answer either.

By engaging the entire patient-centered medical home team with the process, and getting the data right, and helping those collecting the data know what we need, we can hopefully hear the needs of our patients, and this process can really help us fill those needs.

Fred N. Pelzman is an associate professor of medicine, New York Presbyterian Hospital and associate director, Weill Cornell Internal Medicine Associates, New York City, New York. He blogs at Building the Patient-Centered Medical Home

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  • guest

    Ultimately, at the risk of sounding like a grumpy dinosaur, all of this hoopla is really not necessary. What our patients want is pretty simple: for their doctor to have enough time with them so that they can be heard, and so that the care they are provided is of reasonable quality. Maybe if healthcare organizations took the money that is being used to pay administrators and consultants to assess patient satisfaction, and used that money to improve levels of staffing for direct patient care, we would see some results.

    • Suzi Q 38

      I wholeheartedly agree.
      I wrote some negative things once, and not one person from administration called me.
      It really doesn’t matter whether you get a positive or negative evaluation from a patient.
      They won’t do anything if it is positive or negative, anyway.

      • guest

        Well, you are half right! If the survey is negative enough, they will call the doctor in to yell at him or her about it…but the positive surveys are just pretty much taken for granted.

        • Suzi Q 38

          So Is the answer to ignore those stupid evaluation letters?

          I could fill out a really positive one and say that they should give Dr. Abc a thousand dollars for being so nice to me, and perfect in every way….
          They wouldn’t do that, would they?
          So you are right it is there just to slap the hand of the errant doctors that are not so good.

        • whoknows

          I agree. i can see that a satisfaction score sent to indiana when the hospital is 2000 miles away from there, is not going to be of any help to anyone.

          And i have learned that like you said there is no one to complain to. Admins do not understand the gravity of a clinical problem. Seems like at times no one is accountable. What is chilling is the lack of consciousness by the system as a whole.

          • guest

            Well, it’s basically run by businesspeople, who are well known to be fairly sociopathic. Which is pretty much antithetical to the provision of real care.

        • SarahJ89

          I always throw mine away. The last thing I want is to give the greedy folks on the top more to work with.

      • whoknows

        I once complained to “patient relations” about a blunder of something read wrong on an MRI by a surgeon and my concerns being blown off

        .It was not life or death but it was wrong. they took down my concerns and generated a letter that they would help me and then never notified me Nothing got resolved except a lot of admins got paid and once again my concern got lost.

        • guest

          Yep. I was once somewhat disgusted by my treatment in an ED (I was referred there by Urgent Care because of a severe headache following a MVA, and the ED resident didn’t do a PE, just spent about 5 minutes explaining why I didn’t need imaging, I never saw an attending and was sent on my way with scrips for opiate pain meds that I didn’t want or need. P.S. I was an attending in their healthcare system at the time, not that that should make a difference I guess.) I filled out a detailed patient satisfaction summary and spoke with an administrator who called but no real followup at all that I could see was done. But they did get me out fast!

          • whoknows

            You know it does count to be an attending at the same health facility. And if it doesn’t that is down right frightening.
            And it makes me pissed and sad that a resident would tell you as an attending what to do. As a resident I would hope that they would at least be respectful and if not respectful, would be at least vigilant of being sued. But it seems like neither of those factors helped you get the the standard of care.

            This may sound like a strange question. But how do you account for what happened to you? meaning what was so driving them to get you as a patient out of there so quickly even when you tried to slow them down and question their judgment?
            Clearly that resident was being pressured by someone with more authority than you as the attending that would know and as the pt. I am beside myself hearing this. I am assuming that they no longer are able to use clinical judgment and are fearful of admin and insurance.

            On a side note along a similar line, I had major surgery right around the time mangled care was taking over. At the time I had great insurance that would pay for me to stay several days in the hospital. But the hospital I was in only reacted to the fact that everyone with my surgery would stay overnight and leave the next day. No exceptions. The key here is everyone got treated the same.
            Even having the cash or insurance to pay for it, was not a factor in helping you get the extra care. And even though I was in so much pain I could not walk etc.
            They said there was no reason for me to stay and treated me like the other HMO pts there. Everyone got treated the same.

          • guest

            Actually I didn’t really want imaging, I just sort of wanted to be reassured, and I really didn’t want to stay there very long, so I didn’t argue with the resident. And I was still a little dazed from the MVA. But as I was driving away, I thought “Wait a minute! He didn’t even do an exam! Geeesh!”

            Plus,he never asked what kind of work I did, (I looked different from almost everyone else in the waiting room, so most docs will ask you right away what you do) so he didn’t know I was a doc, let alone one on staff in the same system.

            This is what happens when medical practice is reduced to algorithms. You take the humanity out of it, and you end up with residents whose main goal is to clear the waiting room and not interact too much with their patients…and with patients who are discharged in a rush after surgery because the “evidence” says that you only need to stay one day after the procedure…

          • Suzi Q 38

            Next time doctor asks what I do for work, I may tell him/her that I am a nuclear physicist or the cafeteria worker at my kid’s elementary school.

            It should not matter, but you are probably right….it does.

            “……..You take the humanity out of it, and you end up with residents whose main goal is to clear the waiting room and not interact too much with their patients…and with patients who are discharged in a rush after surgery because the “evidence” says that you only need to stay one day after the procedure…”

            So is it better to go to a private hospital in a expensive city? They sent me home at the teaching hospital about 38-40 hours after my c-spine disscection surgery. I was scared to be in there…the nurses rarely came in when you needed them. Thank goodness I could walk.

            My room mate (who was a nurse) couldn’t after her surgery. I would go to the nurse’s station with my IV pole in tow. Also my room was filthy. I never saw a cleaning person. The floors and counters showed visible dirt. I was concerned about nosocomial infection, so asked to be discharged to the care of my daughter, who is a ER nurse.

          • buzzkillersmith

            Wow, that’s lousy medical care. You were right to complain.

          • guest

            Fat lot of good it did me.

          • Suzi Q 38

            Exactly!

      • rbthe4th2

        I bug the people to find out who is in charge of the doctor of the particular area. I say I have nice things to say and I want them heard. So far, every time I’ve badgered someone to give me the front line person who is in charge of the doctor I want to praise has gotten back to me. I’ve put in specific examples and say I want this to go to those doctors because their care is important and I want them to know that. I want admin to know this.
        I get in their face. It does work, but you have to be persistent.
        That being said, I don’t take the same tact as I do with “problems”. I find out who is in charge and give them the documentation. I am persistent but I keep at it.
        Randy

    • whoknows

      love it!

  • 8Pi

    “Medical home;” an antithetical term applied to medical offices, originated by someone high in the federal government, no doubt, and meaning, “cost-saving measures.” A euphemism for wishful thinking in the face of untenable practices, the use of which hopes to obscure them, and give the fantasy of a “happy home.” Well,often they are as dysfunctional and harmful as dysfunctional families, but in the case of the “medical home,” there is nowhere to go but out – out of the system entirely, as one’s “medical home” relations will follow a patient throughout it.

    If you in your “medical homes” would have regular patient reviews, pooling that vast amount of knowledge, if the humanity had not been stripped for both staff and patients, maybe the words would have meaning and use. But calling a shack a mansion ain’t gonna change facts.

    Patient surveys are useless. And, patients are not algorithms, like it or not. You must not forget how much patients want to trust their physicians and other medical practitioners. But communication is poor. Front office staff is often at fault, through no fault of their own, save for not quitting jobs where they are expected to communicate such things as medical information when they have no medical training whatsoever.

    There is nothing “integrated” about the “medical homes.” This pretense is adding yet another layer of artifice to the dysfunctional system.

    And to whom does a patient turn when things are going terribly wrong? Another practitioner within the same system, as they are all one?

    Again, remember that patients want to be able to trust their physicians and every single person in these group offices with their lives. You do not need data. You need to be able to practice medicine.

    PS Hadn’t even seen that you have a “medical home” blog. oy

  • southerndoc1

    “By engaging the entire patient-centered medical home team with the process, and getting the data right, and helping those collecting the data know what we need, we can hopefully hear the needs of our patients”

    If your priorities are “engaging with the process” and “collecting the data,” I think it’s safe to say you won’t be listening to the patients.

  • Suzi Q 38

    It is always different.
    My friend is not a doctor but she is married to one. Once I pointed out that she tells her doctors she is married to Dr. A because she knows it will get her better care. That Is reality.

  • PamelaWibleMD

    EXACTLY! Listen to patients. Duh. I led town hall meeting and allowed patients to design their own clinic. If we want patients to buy-in to the PCMH then let’s put them in the center. Anything less is physician centric and misleading. Patients know what’s up.

    http://www.youtube.com/watch?v=4YJz5wvt2bk