American College of Physicians: Internal Medicine — Doctors for Adults ®

Advertisement
Wednesday, March 14, 2012

Patient rights as a form of customer service

I was talking to a patient a few days ago who was raving about a local grocery store. "They get it," she said. "They understand how to take care of their customers."

It made me think about how far medicine has drifted away from the same idea. Ironically, despite the fact that our "customers" (people who pay us for our services) are seeking us so we can "take care of" them, we do a lousy job of taking care of our customers. It has been an obsession of mine since I started practice, but it has been something that has been increasingly difficult to accomplish.

I now have to fight against the need to meet "meaningful use" criteria so that I can have time to make the record meaningful and useful to my patients. I have to fight against the need to conform to "medical home" criteria so that I can make my practice the place my patients see as their ultimate medical haven. The more the government and insurance industries push me toward focusing on my patients, the less time I have for my patients because of the need to meet criteria proving that I am caring for my patients.

It's a mess.

So I went back to my roots. What do I really think should be the rights of my patients? Here is a list that I made. Patients have the following rights:
1) The right to have access to care when it's needed
a) This does not mean the care is done in the office either. It can be done over the phone or via computer.
b) The schedule of the office should accommodate the patients' needs as much as is reasonable to expect.

2) The right to have care that is convenient
a) They should not have to wait to be seen or wait on the phone to be heard
b) They should not have to come in for problems that can be handled at home or work

3) The right to have a doctor who is not motivated to have sick patients
a) Having a doctor with the same motivation as the patient, to keep them healthy
b) Having a doctor who does not only react to problems, but works to prevent them

4) The right to get care that is not rushed or distracted
a) Visits are as long as they take to deal with the problem
b) Phone calls aren't cut short from fear of offering "free medicine"

5) The right to be treated as the one paying for the service of the doctors and their staff
a) Patients should be satisfied with the "customer experience" in their doctor's office. They should feel like they spent their money wisely.
b) They should never feel like a "number" or that the visit revolves around the doctor.

6) The right to have care that pays attention to cost and does not overdo care
a) Good care does not mean overdoing it. Good care means offering the care that is best. Sometimes (often) that means doing nothing.
b) Expensive labs, tests, and drugs should always be considered as to the benefit they offer versus the cost they incur.
c) The patient should be able to make an informed decision regarding the care they get, increasing their investment in following-through on things.

7) The right to have access to all of their records at any time
a) Online access to records is a must. The lab tests do not belong to the doctor and doctors shouldn't be afraid of the patients seeing them.
b) The part of the chart (most of it, actually) which the patient knows more than the doctor should be available to edit and control by the patient.

8) The right to have a doctor who knows what is going on with them
a) This means that the primary care physician should always have accurate information about any other care the patient has received. Because of the state of our system, this does put some burden on the patient to communicate with the doctor.
b) This means that all specialists should know why the patient is being sent.
c) This means that hospitalists should know what's going on outside of the hospital and the primary care physician should know what's going on in the hospital.
d) This means the primary care physician should regularly review patient records to know if care is being missed.

9) The right to understand their care and not be afraid to ask when they don't
a) Every visit should end up with a clear plan.
b) Preventive services should be clearly understood and spelled out as to when they are due.
c) The patient should have access to the doctor if confusion arises and get a quick answer to any questions.
d) No care should be given without a good explanation.

10) The right to be treated with empathy and respect
a) Medical professionals should understand that it's hard to be sick, to have pain, and to die.
b) The interaction between doctor and patient is a human interaction – the interaction between to flawed individuals. This means an expectation of perfection on either side will only result in bad care.
c) Patients should never be afraid they are going "to get yelled at" by their doctor. They should feel free to be open when they don't do the right thing.

The biggest irony is that making this list allows me to meet some of the criteria for "medical home" and future criteria for "meaningful use." Great. Check that off of my list. The problem is that both of these criteria I am working on meeting have a net negative effect on my patients by making me more busy in checking off tasks and reporting data, giving me less time to actually give my patients these rights.

So what do you think about this list? How should doctors work toward patient rights in a setting where we are increasingly burdened with criteria to prove we are meeting them? How can we meet criteria when they themselves are one of the things keeping us from meeting their own goals?

I want to know what my patients want and what they need. My ultimate goal is to meet those needs like the grocery store is doing, offering such good service that when my patients go to the grocery store they brag to the people there about the good care they get from their doctor.

Imagine that.

After taking a year-long hiatus from blogging, Rob Lamberts, MD, ACP Member, returned with "volume 2" of his personal musings about medicine, life, armadillos and Sasquatch at More Musings (of a Distractible Kind), where this post originally appeared.

Labels: , , , , , ,

0 Comments:

Post a Comment

Subscribe to Post Comments [Atom]

<< Home

Share

 

Contact ACP Internist

Send comments to ACP Internist staff at acpinternist@acponline.org.

Blog log

Members of the American College of Physicians contribute posts from their own sites to ACP Internistand ACP Hospitalist. Contributors include:

Albert Fuchs, MD
Albert Fuchs, MD, FACP, graduated from the University of California, Los Angeles School of Medicine, where he also did his internal medicine training. Certified by the American Board of Internal Medicine, Dr. Fuchs spent three years as a full-time faculty member at UCLA School of Medicine before opening his private practice in Beverly Hills in 2000.

And Thus, It Begins
Amanda Xi, ACP Medical Student Member, is a first-year medical student at the OUWB School of Medicine, charter class of 2015, in Rochester, Mich., from which she which chronicles her journey through medical training from day 1 of medical school.

Auscultation
Ira S. Nash, MD, FACP, is the senior vice president and executive director of the North Shore-LIJ Medical Group, and a professor of Cardiology and Population Health at Hofstra North Shore-LIJ School of Medicine. He is Board Certified in Internal Medicine and Cardiovascular Diseases and was in the private practice of cardiology before joining the full-time faculty of Massachusetts General Hospital.

Zackary Berger
Zackary Berger, MD, ACP Member, is a primary care doctor and general internist in the Division of General Internal Medicine at Johns Hopkins. His research interests include doctor-patient communication, bioethics, and systematic reviews.

Controversies in Hospital Infection Prevention
Run by three ACP Fellows, this blog ponders vexing issues in infection prevention and control, inside and outside the hospital. Daniel J Diekema, MD, FACP, practices infectious diseases, clinical microbiology, and hospital epidemiology in Iowa City, Iowa, splitting time between seeing patients with infectious diseases, diagnosing infections in the microbiology laboratory, and trying to prevent infections in the hospital. Michael B. Edmond, MD, FACP, is a hospital epidemiologist in Richmond, Va., with a focus on understanding why infections occur in the hospital and ways to prevent these infections, and sees patients in the inpatient and outpatient settings. Eli N. Perencevich, MD, ACP Member, is an infectious disease physician and epidemiologist in Iowa City, Iowa, who studies methods to halt the spread of resistant bacteria in our hospitals (including novel ways to get everyone to wash their hands).

db's Medical Rants
Robert M. Centor, MD, FACP, contributes short essays contemplating medicine and the health care system.

Suneel Dhand, MD, ACP Member
Suneel Dhand, MD, ACP Member, is a practicing physician in Massachusetts. He has published numerous articles in clinical medicine, covering a wide range of specialty areas including; pulmonology, cardiology, endocrinology, hematology, and infectious disease. He has also authored chapters in the prestigious "5-Minute Clinical Consult" medical textbook. His other clinical interests include quality improvement, hospital safety, hospital utilization, and the use of technology in health care.

DrDialogue
Juliet K. Mavromatis, MD, FACP, provides a conversation about health topics for patients and health professionals.

Dr. Mintz' Blog
Matthew Mintz, MD, FACP, has practiced internal medicine for more than a decade and is an Associate Professor of Medicine at an academic medical center on the East Coast. His time is split between teaching medical students and residents, and caring for patients.

Everything Health
Toni Brayer, MD, FACP, blogs about the rapid changes in science, medicine, health and healing in the 21st century.

FutureDocs
Vineet Arora, MD, FACP, is Associate Program Director for the Internal Medicine Residency and Assistant Dean of Scholarship & Discovery at the Pritzker School of Medicine for the University of Chicago. Her education and research focus is on resident duty hours, patient handoffs, medical professionalism, and quality of hospital care. She is also an academic hospitalist.

Glass Hospital
John H. Schumann, MD, FACP, provides transparency on the workings of medical practice and the complexities of hospital care, illuminates the emotional and cognitive aspects of caregiving and decision-making from the perspective of an active primary care physician, and offers behind-the-scenes portraits of hospital sanctums and the people who inhabit them.

Gut Check
Ryan Madanick, MD, ACP Member, is a gastroenterologist at the University of North Carolina School of Medicine, and the Program Director for the GI & Hepatology Fellowship Program. He specializes in diseases of the esophagus, with a strong interest in the diagnosis and treatment of patients who have difficult-to-manage esophageal problems such as refractory GERD, heartburn, and chest pain.

I'm dok
Mike Aref, MD, PhD, FACP, is an academic hospitalist with an interest in basic and clinical science and education, with interests in noninvasive monitoring and diagnostic testing using novel bedside imaging modalities, diagnostic reasoning, medical informatics, new medical education modalities, pre-code/code management, palliative care, patient-physician communication, quality improvement, and quantitative biomedical imaging.

Informatics Professor
William Hersh, MD, FACP, Professor and Chair, Department of Medical Informatics & Clinical Epidemiology, Oregon Health & Science University, posts his thoughts on various topics related to biomedical and health informatics.

David Katz, MD
David L. Katz, MD, MPH, FACP, is an internationally renowned authority on nutrition, weight management, and the prevention of chronic disease, and an internationally recognized leader in integrative medicine and patient-centered care.

Just Oncology
Richard Just, MD, ACP Member, has 36 years in clinical practice of hematology and medical oncology. His blog is a joint publication with Gregg Masters, MPH.

KevinMD
Kevin Pho, MD, ACP Member, offers one of the Web's definitive sites for influential health commentary.

MD Whistleblower
Michael Kirsch, MD, FACP, addresses the joys and challenges of medical practice, including controversies in the doctor-patient relationship, medical ethics and measuring medical quality. When he's not writing, he's performing colonoscopies.

Medical Lessons
Elaine Schattner, MD, FACP, shares her ideas on education, ethics in medicine, health care news and culture. Her views on medicine are informed by her past experiences in caring for patients, as a researcher in cancer immunology, and as a patient who's had breast cancer.

Mired in MedEd
Alexander M. Djuricich, MD, FACP, is the Associate Dean for Continuing Medical Education (CME), and a Program Director in Medicine-Pediatrics at the Indiana University School of Medicine in Indianapolis, where he blogs about medical education.

More Musings
Rob Lamberts, MD, ACP Member, a med-peds and general practice internist, returns with "volume 2" of his personal musings about medicine, life, armadillos and Sasquatch at More Musings (of a Distractible Kind).

Prescriptions
David M. Sack, MD, FACP, practices general gastroenterology at a small community hospital in Connecticut. His blog is a series of musings on medicine, medical care, the health care system and medical ethics, in no particular order.

Reflections of a Grady Doctor
Kimberly Manning, MD, FACP, reflects on the personal side of being a doctor in a community hospital in Atlanta.

The Blog of Paul Sufka
Paul Sufka, MD, ACP Member, is a board certified rheumatologist in St. Paul, Minn. He was a chief resident in internal medicine with the University of Minnesota and then completed his fellowship training in rheumatology in June 2011 at the University of Minnesota Department of Rheumatology. His interests include the use of technology in medicine.

Technology in (Medical) Education
Neil Mehta, MBBS, MS, FACP, is interested in use of technology in education, social media and networking, practice management and evidence-based medicine tools, personal information and knowledge management.

Peter A. Lipson, MD
Peter A. Lipson, MD, ACP Member, is a practicing internist and teaching physician in Southeast Michigan. The blog, which has been around in various forms since 2007, offers musings on the intersection of science, medicine, and culture.

Why is American Health Care So Expensive?
Janice Boughton, MD, FACP, practiced internal medicine for 20 years before adopting a career in hospital and primary care medicine as a locum tenens physician. She lives in Idaho when not traveling.

World's Best Site
Daniel Ginsberg, MD, FACP, is an internal medicine physician who has avidly applied computers to medicine since 1986, when he first wrote medically oriented computer programs. He is in practice in Tacoma, Washington.

Other blogs of note:

American Journal of Medicine
Also known as the Green Journal, the American Journal of Medicine publishes original clinical articles of interest to physicians in internal medicine and its subspecialities, both in academia and community-based practice.

Clinical Correlations
A collaborative medical blog started by Neil Shapiro, MD, ACP Member, associate program director at New York University Medical Center's internal medicine residency program. Faculty, residents and students contribute case studies, mystery quizzes, news, commentary and more.

Interact MD
Michael Benjamin, MD, ACP member, doesn't accept industry money so he can create an independent, clinician-reviewed space on the Internet for physicians to report and comment on the medical news of the day.

PLoS Blog
The Public Library of Science's open access materials include a blog.

White Coat Rants
One of the most popular anonymous blogs written by an emergency room physician.

Powered by Blogger

RSS feed