Recently, a friend of mine described the experience she had going to an appointment with her family physician. When she entered the office, the receptionist asked her to give name, address, and other personal information out loud, and in a waiting room full of patients. My friend requested to write down the information on a piece of paper and hand it to the receptionist–a request which was denied. Needless to say, this was not a great start to a visit that took another forty five minutes before she was finally in the presence of the doctor.
The doctor was kind and gentle. However, by her 3 PM appointment, he was already visibly tired, with sagging shoulders and frequent sighs. The doctor explained that he had just come from making rounds as a hospitalist to supplement his income. He was running late and still had a room full of patients who needed to be seen before the day’s work was complete. My friend felt sorry for the physician and decided not to dwell on the issue that had brought her to the doctor, but instead helped him finish the visit as expeditiously as possible.
While my friend’s story is not necessarily a regular happening, it is not all that rare. After hearing her story, I sought out the opinions of more friends to find out what they expected/wanted when they went to see a doctor. Then I asked about how their experiences compared with the ideal. Below is what they had to say.
As our country begins to implement the Affordable Care Act (ACA), American medicine is under scrutiny: health care providers are under increasing pressure to provide increased access to quality health care at an affordable price. Though the ACA has spurred much discussion about the effect it will have on almost every aspect of health care in the nation, there’s something else that will have an even larger impact on health care in the coming years. The biggest impact on health care in the coming decades will be from technology – it will change the way we understand and treat diseases and provide preventive care. But more about that later, for now, back to my friend:
Patients want to be seen by their health care provider in a clean and comfortable facility operated by kind and considerate professional staff. As is true of almost any business, the front office staff is the face of the organization. This includes interactions both over the telephone and in person. Many people are nervous or anxious when going to see a doctor, and a soothing and comforting presence in the person of the receptionist or nurse is a welcome beginning to the meeting with the doctor. According to my friends, in many physician offices these expectations are rarely met.
Patients want their physician to be on time and prepared for the appointment. While unavoidable in some instances, waiting times over fifteen minutes are not well tolerated by patients of today. Physicians are notorious for being late and unprepared for appointments. Once with the physician, patients expect to be in the presence of a professional who is well informed. This means many things, but at the most basic level, the physician should have spent sufficient time going through the information already available in that mass of medical history paperwork the patients have to fill out in the waiting room, as well as from previous visits, lab reports, and records sent over from other physicians the patient has seen. When the doctor arrives late and unprepared, it creates the impression that the doctor really does not want to spend any effort to get to know the patient well or is not interested in that patient’s wellbeing. Either way, it is not a confidence builder for the patient.
Patients expect their physicians to show genuine interest in them as individuals. Lack of eye contact and focus are a definite negative in this context. In addition, being a poor listener or being dismissive of the patient’s complaints can easily affect the patient-doctor relationship in a negative way.
And how should patients leave the visit? They would like to leave their doctor fully informed about the findings by the physician and instructed about the next steps that need to be taken.
Very often patients do not understand what is expected of them at the end of the visit, and as a result, do not follow the instructions. Patients find the use of technical terms and hurried explanations as impediments to understanding about the condition that led them to see the doctor and what they need to do to improve their health. This results in less than ideal outcomes for all concerned.
The large majority of physicians that I have interacted with chose medicine as a career with the intent of doing good work and helping others. The idealism and enthusiasm—and in some cases even a touch of naiveté—that go into choosing medicine as a career is difficult to sustain over a period of time. The middle-aged figure in white coat that you see is often only a shell of the bright, enthusiastic person who entered the profession for all the right reasons.
So what happened?
Doctors are squeezed from many sides today and are burning out. Here are a few reasons why:
1. According to the American Medical Association (AMA), more than half the physicians practicing today are employed by health care entities. Quickly disappearing are the days when doctors ran their own practices. This loss of autonomy has resulted in what we call “employed physicians,” who have four major complaints :
- Employed physicians often lack decision making control about staff and personnel they work with. This can have a significant impact on the efficiency of the practice and the smooth flow of patients and patient satisfaction.
- Employed physicians feel they are being bossed around by “less educated” people who are in charge of running the business. Very often physicians end up reporting to individuals whom they consider to be less qualified (because of their lack of medical knowledge) than they are.
- Employed physicians often have little control over billing and coding. Physicians are used to having the ability to waive charges or pick out the codes that they deem most appropriate for the given procedure.
- Many employed physicians resent being forced to use new, system wide technology. Technology decisions may make perfect sense for the controlling business entity, but they can become frustrations for the physicians.
2. Doctors are constantly stressed out.
The stresses of the profession start with the responsibility of being the guardian of the health of his/her patients. Add to this the stress and strain of dealing with the rapid changes that deeply impact almost every aspect of the profession. These constant stresses affect most physicians and can ultimately reshape personality. By some estimates more than half of the physicians in the prime of their careers are burnt out or are heading in that direction. Typically such issues go unacknowledged and unaddressed.
3. Doctors are often unfairly perceived in modern society as rich, entitled, and overcharging.
That health insurance reimbursements for physician services are being reduced is an uncomfortable reality. Most physicians start their careers with a hefty student loan—often in the hundreds of thousands of dollars. By the time this debt is paid off and the physician is in the prime of his/her career, along comes the ACA and other changes that affect the capacity to generate the anticipated income. Financial matters only compound the problems addressed earlier.
Doctors take pride in their profession and find reward in the health and satisfaction of their patients. However, with an ever increasing patient load resulting in less time with individual patients, that satisfaction becomes more difficult to achieve. Add in an adversarial legal system that makes every patient a potential lawsuit…well, you can see where this is going.
So, is the system doomed to fail? Or, is there hope for change and improvement?
In blow #2 of this series, I will talk more on that and on how to improve the quality of the health care profession. Stay tuned!