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Why Did My Patient Leave Me?

cancer.nautil.us

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Re: Why Did My Patient Leave Me?

#21

Post by ThomPete »

peferron wrote: post #16
jacquesm wrote: post #4

I've done this, without feedback. The reason was that doctors seem to come in several varieties when it comes to bringing their ego to work and my doctor had a serious case of that. I was dehydrated after an operation and when he asked if he could do something for me I asked for some water, the doctor then ordered someone else not in the room to come and get me a glass of water. He couldn't be bothered to walk to the…

Regarding your first point, that's especially striking in the USA. There seems to be at least 4-5 assistants (nurses, secretaries...) for each doctor. Assistants check you in; you're left waiting in a room; after a seemingly random period of time, the doctor suddenly barges in, diagnoses you faster than the Flash, and leaves just as suddenly; assistants check you out. I get that it's very efficient to work this way,…

Thats actually a very efficient way of doing things and they get through way more patients a day.

Re: Why Did My Patient Leave Me?

#22

Post by ljoshua »

Herodotus38 wrote: post #17
ljoshua wrote: post #9

This is a growing and very important aspect of value-based care, and really factors into the discussion of quality that will be more a part of reimbursement than it ever has been. The article focused mostly on the provider him or herself, but patients also take into account the entire experience, including office staff, scheduling and billing procedures, etc. Shameless self promotion: this is the exact problem my co-…

It looks like your model uses immediate or nearly so text messaging after an interaction. Since a phone number is protected health information as per HIPAA, I'd be interested in how it's been setting a business associate contract? I imagine there is quite a bit of red tape. Are you able to set up one and use it for each clinical entity or does it require a bit of individualization?

Indeed, you're right. It follows a similar model to services that do appointment reminders via text message, which is becoming very common.

The permission check becomes vital: it's part of the patient authorization at, for example, a first visit, and is best when also followed by a verbal authorization upon checkout. It's one of the big hurdles we're trying to overcome obviously, but we believe there are proper ways to do it and make it work within the boundaries of regulation and privacy. No good problem worth solving is without difficulties, right? :)

Re: Why Did My Patient Leave Me?

#23

Post by danieltillett »

tim333 wrote: post #14
danieltillett wrote: post #8

I have luckily been very healthy in my life, but I have always believed that the relationship between a doctor and a patient is a collaboration with the aim being to help the patient make the most appropriate decision for their needs. Too many doctors seem to be of the opinion they know best and the patient should just do as they say - even if they are correct technically it is not their life that is on the line. The…

Not sure the patient is always right but the docs are often wrong. Collaboration probably works best. The docs have more medical knowledge but the patient may know more about their particular condition. I recently went to a dentist with a broken tooth and he wanted to do a root canal not because their was any evidence it was infected but because he thought it might be and why not from his point of view. From mine I'd…

Collaboration would work best, but it is rarely used by medical doctors. It is amazingly hard to establish a collaborative relationship in medicine, despite it being the norm outside of medicine.

As a general rule delaying treatment is almost always the best option. I am glad you avoided an unneeded root canal.

Re: Why Did My Patient Leave Me?

#24

Post by ThomPete »

jacquesm wrote: post #18
peferron wrote: post #16

Earlier quoted context omitted.

Regarding your first point, that's especially striking in the USA. There seems to be at least 4-5 assistants (nurses, secretaries...) for each doctor. Assistants check you in; you're left waiting in a room; after a seemingly random period of time, the doctor suddenly barges in, diagnoses you faster than the Flash, and leaves just as suddenly; assistants check you out. I get that it's very efficient to work this way,…

France has some of the best healthcare in the world. A family member was involved in a horrific truck/passenger bus accident in France near Metz and I spent the better part of a week in and out of their intensive care department visiting. I've never seen a hospital that I liked better. Everybody was so unbelievably nice and caring it was a huge improvement over what I'd seen elsewhere. http://krant.telegraaf.nl/krant…

I do question the sustainability of the french system though and that of many other european systems.

Its important to remember that in a state economy where healthcare is free or semi free it's operated as a cost center and thus has budgets that are politically mandated not determined by market demand at least not directly.

This leads to a number of limitations on what kind of care patients can get what machines they can buy, what medicine etc.

Not saying the US system is better but all systems have drawbacks.

Re: Why Did My Patient Leave Me?

#25

Post by throwaway1909 »

jacquesm wrote: post #4

I've done this, without feedback. The reason was that doctors seem to come in several varieties when it comes to bringing their ego to work and my doctor had a serious case of that. I was dehydrated after an operation and when he asked if he could do something for me I asked for some water, the doctor then ordered someone else not in the room to come and get me a glass of water. He couldn't be bothered to walk to the…

What was the situation here, exactly? You describe a situation of being thirsty and a doctor calling to you get you water. Then you got the water and presumably your thirst was satiated. Healthcare is provided by entire teams of people, not just by doctors. Doctors are part of the service, but they rely on a team for a great many things.

Re: Why Did My Patient Leave Me?

#26

Post by jacquesm »

ThomPete wrote: post #24
jacquesm wrote: post #18

Earlier quoted context omitted.

France has some of the best healthcare in the world. A family member was involved in a horrific truck/passenger bus accident in France near Metz and I spent the better part of a week in and out of their intensive care department visiting. I've never seen a hospital that I liked better. Everybody was so unbelievably nice and caring it was a huge improvement over what I'd seen elsewhere. http://krant.telegraaf.nl/krant…

I do question the sustainability of the french system though and that of many other european systems. Its important to remember that in a state economy where healthcare is free or semi free it's operated as a cost center and thus has budgets that are politically mandated not determined by market demand at least not directly. This leads to a number of limitations on what kind of care patients can get what machines the…

Good point. I'm not too worried about France, they seem to have their priorities straight there, other countries are less stable. Especially in former Eastern European countries there are disasters happening right now, and many Western countries will have to come to terms with the cost of health care and attempting to take commerce out of it.

NL had a very good system which got replaced by something much less efficient, ostensibly because the 'market' would have been better at making things efficient where the only real change is that healthcare is now much more expensive and options are as limited as they were before.

Personally I feel a good society should take care of its sick, poor, elderly and inmates even if it costs but that's an opinion that seems to be out of fashion.

Re: Why Did My Patient Leave Me?

#27

Post by cm2187 »

peferron wrote: post #16
jacquesm wrote: post #4

I've done this, without feedback. The reason was that doctors seem to come in several varieties when it comes to bringing their ego to work and my doctor had a serious case of that. I was dehydrated after an operation and when he asked if he could do something for me I asked for some water, the doctor then ordered someone else not in the room to come and get me a glass of water. He couldn't be bothered to walk to the…

Regarding your first point, that's especially striking in the USA. There seems to be at least 4-5 assistants (nurses, secretaries...) for each doctor. Assistants check you in; you're left waiting in a room; after a seemingly random period of time, the doctor suddenly barges in, diagnoses you faster than the Flash, and leaves just as suddenly; assistants check you out. I get that it's very efficient to work this way,…

To me this looks like a basic productivity thing. Health services is the only sector that never industrialized, it's a craft industry. You have a highly educated, highly paid specialist in front of every client. It would be absurd (and uneconomical) to make him do the job of a receptionist in top of that.

Re: Why Did My Patient Leave Me?

#29

Post by Herodotus38 »

ljoshua wrote: post #22
Herodotus38 wrote: post #17

Earlier quoted context omitted.

It looks like your model uses immediate or nearly so text messaging after an interaction. Since a phone number is protected health information as per HIPAA, I'd be interested in how it's been setting a business associate contract? I imagine there is quite a bit of red tape. Are you able to set up one and use it for each clinical entity or does it require a bit of individualization?

Indeed, you're right. It follows a similar model to services that do appointment reminders via text message, which is becoming very common. The permission check becomes vital: it's part of the patient authorization at, for example, a first visit, and is best when also followed by a verbal authorization upon checkout. It's one of the big hurdles we're trying to overcome obviously, but we believe there are proper ways…

I wish you luck. I think your approach is far better than the mailed sheets of paper surveys I inevitably toss in the recycling bin that arrive 1-2 weeks after my children's appointments. Do you guys use any sort of incentive to boost responses?

Re: Why Did My Patient Leave Me?

#30

Post by tomohawk »

Years ago, I had a truly great primary care doctor. She had her own practice, which was typical at that time. She was caring, but above all, extremely competent. After she retired, I've yet to come across a situation remotely as good.

I think she was so good because she was allowed to be directly engaged with her patients and that resulted in some sort of feedback loop where she was always striving to stay on top of the state-of-the-art.

These days, those sorts of practices are hard to find. There's the doc-in-a-box places that dominate, and they seem surprised if you want to see the same doc rather than whoever can just see you.

There's also someone else in the room these days - the government and (practically the same thing) insurance company. The doctor / patient relationship is now more like the doctor stooge snooping on the patient relationship.

Just look at how many doctors no longer will prescribe medicine for pain due to the war on drugs. They're scared of losing their license. The collateral damage is the poor people who need strong pain management but find it increasingly hard to get it.

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