Comments

Fabulous Tom - thanks for this.

I have rattled this cage for years. At last we are waking up to reality. Brilliant Docs are not always the best communicators. Of course I want the best technical doctor when I need it and he can be Basil Fawlty's double as far as I am concerned if he is a brilliant surgeon and ‘mends’ me. Wouldn’t it be just wonderful if he or she was a nice person as well? I have told the story many times of the patient who would not sue her doctor once she found out the mistake was made by the family doctor and not the hospital surgeon as she first thought. Why did she withdraw her complaint? - Because she liked her Family Doctor.

I am certainly nice people who are crap doctors. I strongly believe - and the evidence is growing - that good communication with patients not only increases patient satisfaction but also improves job satisfaction for the doctor and so we have a win-win-win scenario because the patient gains, the doctor gains and the institution gains. Fabulous topic – I hope it flies!

Simplicity once more :-)

Posted by Trevor Gay at December 2, 2005 8:39 AM

From a practical POV, high patient satisfaction (often driven by the bedside manner you described) is also highly correlated with lower malpractice claims. It seems that patients that like their doctors are significantly less likely to sue them.

Posted by David Porter at December 2, 2005 8:40 AM

Not that I'm defending bad doctors, but sometimes there are also bad patients: http://www.msnbc.msn.com/id/9063638/

Posted by Francis Wu at December 2, 2005 10:31 AM

Bad Docs provide Bad Medicine. While the Doc can place orders for care and drugs it is the responsibility of the patient for most of their own health. Thus Good Docs TELL (SELL) the patient on their responsibilities and get the patient and the patient's family INVOLVED in their care and decisions about their care.

Also, contrary to what we often believe, healthcare if often not practiced as a science, it has been practiced as an art. We need to get doctors to use science (evidence, data supported treatments) in their practice of medicine.

Posted by Dave Holland at December 2, 2005 11:06 AM

Dave - Most Doctors will tell you that a lot of it is about 'intuition' as much as evidence based. It is about probability and experience. Whilst on the subject of evidence based practice we maybe ought to think about applying the same rules on managers in healthcare. In my career many arrogant managers demand to know from doctors where is the evidence base for a development the doctor wants some new money for and yet when challenged to illustrate their own evidence base for management decisions there is a deafening silence from the manager.

Yep Francis of course there will be patients who take advantage of and even abuse the system - such is life I am afraid but the huge majority of patients are looking for help, caring and professional help and will not abuse the professionals. Dr Neil Baum has a motto that Tom Peters has quoted;

Rule A - The patient is always right

Rule B - if the Patient is wrong - refer to Rule A

That looks good to me :-)

Posted by Trevor Gay at December 2, 2005 5:57 PM

Docking docs who don't satisfy? How sadistic can managed care get?

These are the same docs who feel forced by the insanity of the system to run around like chickens with their heads cut off in order to process enough patients through their practices so they can earn a living (and not a huge one, at that!). Nothing like setting people up to fail. Gah.

In a conversation with two internist pals, one shared (as the other sat quietly nodding his agreement) that he has to see so many patients in a day that he can't spend more than a few minutes with those he sees (more and more patients are seen by his PAs). Further, he simply doesn't have time to "know" the patients, anymore; he’s often reviewing a patient’s records as he’s supposed to be listening to the patient talk about whatever caused his visit that day.

I shared a story about a friend of mine who went for her annual physical. The doc did the usual tests, and she heard nothing from him—which was, he’d told her, how she’d know that everything was fine.

The next year, she went back for her physical, and as he read her chart, he said, “I see you never came back in to do the fasting glucose.” “I was never contacted about it,” she replied. “Oh. We sent you a card. Well, it’s probably nothing, but I was concerned that you might have developed diabetes.”

As it turned out, her tests THAT year showed she did. And, she’d probably had it for the whole year prior, but because his practice was so insanely huge and busy, checking to see if she responded to the card they sent wasn’t something they had time to do.

My pals grimaced, but said they completely understood how that happened. Scary, that. I bet a lot more of it goes on than we hear about, though.

My pal went on to share that he also doesn't have time to learn what he really should know about drugs, and often only knows (and recommends) what the pharmaceutical reps currently tout (another reason why patients have to be proactive about their own care).

He told me he won’t even walk through his waiting room, anymore, because he can’t bear the unhappiness he sees on the faces of the patients he knows have been waiting to be seen for far too long.

They’re both great doctors, but tired and overwhelmed, and see no way off their gerbil wheels.

So I suggested they consider creating a boutique/concierge practice (PSF!), so they can get back to what they love doing--helping to keep people well, and healing those who are ill. As of this writing, they’re looking into it.

I'd gladly pay the fee to have my internist's genuine attention, focus, time, and considered participation in my health care. Given that the annual fee for a place in such a practice can be paid through Section 125 plans, FSAs, MSAs, and HRAs, saying yes would be even easier for me.

I do get that not all people believe they can afford such a fee on top of insurance premiums, but the way I see it... smaller practices + less harried docs + more individualized attention + better service = well… could it possibly be BETTER HEALTH (for me and my doc, too)? Why isn’t this a no-brainer?

While that level of care should be what each of us gets from the current system, we simply don't, and, IMO, we're never going to. I’d rather materially participate in a practice where I know my interests are being looked after, than take my chances in another where I might only have to shell a $10 co-pay, but don’t actually know whether anyone is paying attention to my well-being.

Posted by Stacy Brice at December 2, 2005 10:22 PM

Stacy, sorry time does not permit a thorough answer. The point about the evaluations, to my mind, is that some docs do well and others poorly--in the same plans; meaning that, for example, they are all more or less seeing the same number of patients (too many in most instances, to be sure). I have a good friend in an urban pediatrics practice group, which plays by the same rules as its peers, yet her small group is almost alone in guaranteeing parents that one of the group's docs will go to the hospital 100% of the time, 24/7, when one of the practice's thousands of patients (children) is admitted. Most groups in similar circumstances would let the hospital duty docs take care of it in the wee hours. Some management consultants are good listeners, some aren't--so too docs regardless of constraints.

Posted by tom peters at December 4, 2005 11:36 PM

Great points Stacey. The reality is that most of the people most of us, most of the time look after their own health. If our illness cannot be fixed by us, our family or our friends, then we go to the pharmacist for help. If that fails we go to our family doctor. If he/she cannot help we go the hospital. Hospitals are often therefore at least the third attempt – not the first, unless of course it is an acute emergency such as an accident or collapse. We need to put more emphasis - and that means money - into health promotion and ill health prevention. To use your words that is a ‘no brainer.’ What happens is that the ‘glamorous’ bits of healthcare i.e. hospitals, get more money and the prevention bit which is less glamorous get less money. It is as simple as that and 'twas ever thus. As regards individual doctors I have spent a career working with doctors – hundreds of them. Like all professions there are fantastic doctors, there are crap doctors and there are a whole lot in the middle. In my experience almost without fail I have been impressed with the dedication and care that doctors show for their patients. Doctors get bad press too often. The bad ones deserve everything they get but the good ones deserve support and understanding. All doctors cannot be tarred with the same brush and I suspect good doctors want nothing more than exposure of bad doctors! The job of health care managers is to make the job of clinical staff easier as well as inventing complex processes to measure clinical performance.

As Tom says about this 'listening' thing - some doctors just 'have it' and some just 'don't have it' regardless of how busy they are. Doctors are quite rightly held to account more highly than most professions but we tend to forget doctors are human beings with precisely the same frailties, anxieties, pressures and hang ups as all of us.

Posted by Trevor Gay at December 5, 2005 3:59 AM

Trevor, and I'd add that until recently the "med school culture" has encouraged the aura of "doc omnipotence"--all too often docs have not wished to be bothered by patient interruptions--and that attitude precedes managed care (in the case of the U.S.) by decades! The likes of listening hangs in there with prevention and wellness as "medicine's neglected arts." (The apparently accurate story line in the U.S. and elsewhere is more or less that docs were mortal until penicillin came along ... then they became immortal healers.)

Posted by tom peters at December 5, 2005 7:29 AM

Tom, right on the money... Med school culture is doc omnipotence! They fail to teach teamwork, listening, working together. Thus, while the patient is screaming about one pain, they often are focused on something else. I've heard, way to many times, at my hospital nurses say, "I told the doc about it for three days, the data confirmed it and yet he/she wouldn't listen". It's amazing, but the nurses (who are spending time WITH the paitent) are often the most knowledgable about what is going on.

Posted by Dave Holland at December 5, 2005 1:41 PM

Tom and Dave - I am with you guys. The 'old school' Docs were taught that they were God not just training to be God. The good news is that Docs in the UK at least are beginning to get into teamwork and other more 'soft and fluffy stuff' (not my words but the words of a very good Doctor friend of mine). He calls me the 'soft and fluffy' one. Actually he and I are now running joint Doc/Manager workshops on Innovation over here in the UK - happy to share content with both of you on that concept - if you are interested let me know. trevor.simplicity@gmail.com.

I will never defend crap doctors any more than crap politicians or crap managers but I will always give my loyal and utmost support to docs who are genuinely committed to the patient first. I have been reading recently more about St Augustine and his antics under the plane tree Tom and he certainly was an interesting character. Anyway enough rambling from me on an overcast Tuesday morning ...Annie and I have an important engagement with the retail outlets of Birmingham City Centre ... Wow are we looking forward (not) to Christmas shopping today – but I am sure our glass of wine at lunchtime will ease the pain :-)

I am really please healthcare is getting coverage on Tom’s Blog - more of it please big man!!

Posted by Trevor Gay at December 6, 2005 4:19 AM