World-of-Work Map

My son took the ACT in preparation for college applications. On the back of the scoring report, the ACT provided its World-of-Work Map. The World-of-Work Map organizes occupations into clusters, graphically showing how different jobs relate to primary work tasks. The primary work tasks include working with data, working with things, working with ideas and working with people.

The assignment of health care workers into this chart is quite insightful, and perhaps a little problematic. The chart lists two forms of health care work groups, specifically “health care” and “medical diagnosis and treatment.” By health care, the chart refers to hands-on professionals like athletic trainers, dental hygienists and health service administrators. Under “medical diagnosis and treatment,” the chart includes doctors, dentists and veterinarians.

The placements of these two categories on the chart are quite different. The health care workers are listed in the range for “working with people.” These jobs are for “people persons,” those who like helping, caring, serving for, and selling things to other people. In contrast, the “medical diagnosis and treatment” jobs section is on the chart just about smack in the middle of the section for people who like working with ideas. These medical jobs, according to the chart, should appeal to people who like to work with ideas; in other words, people who like gaining knowledge, insights and new ways of expression.

Based on what we know about what drives patient satisfaction and about what it takes to be a good physician from a patient’s perspective, this chart underestimates the importance of working with people for a career in medicine. Sure, it’s important for physicians to be good at ideas, to understand science, to make accurate diagnoses and provide effective, safe treatments. That alone isn’t enough, though. Doctors have to be personable, and they have to establish effective relationships with their patients.   

Singapore

Admittedly, I don’t know the details of the Singapore health system. This link suggests Singapore has something valuable to teach us: http://stossel.blogs.foxbusiness.com/2009/12/23/the-singapore-alternative/.

When it comes to bringing down the cost of medical care in the United States, I think we need patients to have a financial stake in their health care decision-making. Once we do, there will be strong economic incentives to bring down the cost of care. This is such a basic concept, and I hope we will quickly see a “public option” based on health savings accounts.

Pre-Existing Conditions

In a discussion of health care reform, the AARP magazine reported on a proposal to extend Medicare eligibility to people ages 50-64. The magazine reported that no denial of coverage for pre-existing health problems would mean greater access to affordable insurance. I’m not so sure. The idea of having insurance without denying coverage because of pre-existing conditions violates the whole idea of “insurance.”

Insurance is something someone pays to insure against a risk. A pre-existing condition is a known event, not a risk. In theory, if there were no denials for pre-existing condition, the logical thing for people to do would be to not purchase insurance until the person became ill and needed coverage. The cost of coverage would become dramatically higher.

With DrScore, we hope to enhance the quality of U.S. medical care by giving doctors feedback. There are plenty of other issues to deal with in our health system, the two greatest being giving more people access to our terrific medical care and finding a way to reduce the cost of the medical care system. Creating a system that discourages people from having insurance (by eliminating restrictions on coverage of pre-existing conditions) doesn’t seem like it will address the underlying problem.

Lessons from NASCAR’s Attention to Detail

My son recently watched a National Geographic television program on the use of very high-speed photography. The first part of the program described the use of high-speed photography to evaluate efficiency of NASCAR pit crews. The attention to detail is extraordinary. NASCAR racing, according the program, is a race against time. Richard Childress Racing, a very successful racing team, uses high-speed photography to improve their pit crew performance.

Matt Clark, pit crew coach and director of human performance and leadership development at Childress Racing analyzes the slow motion footage to look at details as minimal as pit crew members’ foot placement, air drill angle, and anything else he can find to help shave time off pit stops, improve efficiency and get an edge.

Then comes the follow up, paying particular attention to the people on the team. The equipment has already been optimized; now they have to optimize the people. Individualized training is done to make each person the best member of the team possible.

While this NatGeo program may not have been designed to be a story about patient satisfaction in the office, it certainly offers lessons. Medical care is at least as important as NASCAR. And like NASCAR, great medical care is a team effort, one for which each individual team member is a critical part. Every medical office ought to have a director of human performance and leadership development, working to identify at every step of patients’ experiences how the process of care can be enhanced. And just as critically, attention should be paid to the development of each member of the health care team, training them to provide patients a personal, caring medical visit.

Right Diagnosis, Right Treatment — Patient Is Still Unhappy

A patient came to the office today with benign keratoses — small, scaly, brown, “stuck on” looking, waxy lesions that aren’t cancer or even precancerous. The patient had already seen another dermatologist and was completely dissatisfied with the care she received, because the other dermatologist dismissed the lesions as nothing to worry about.

The other dermatologist had made the right diagnosis. The other dermatologist had prescribed what was arguably the correct treatment for these benign lesions: do nothing. But despite giving the patient the right diagnosis and the right treatment, the patient perceived the care she received as a major disappointment.

I won’t judge the other dermatologist. I wasn’t there when the patient was examined. At the same time, I don’t question that the patient wasn’t satisfied with the care she received. Often, it takes more than making the right diagnosis and prescribing the right treatment to satisfy patients. In fact, if you look at the comments patients make on DrScore.com, you find that other aspects of care are the primary reason patients are satisfied or dissatisfied with their care. If you’re interested in more information on this, check out the DrScore research paper on the topic: http://www.drscore.com/press/papers/whatpatientswant.pdf.

Internet Use by Seniors

One concern friends have occasionally shared with me about DrScore is that senior citizens, among the more common users of Medical care, might not use DrScore because they don’t use the Internet. Those friends may not recognize how pervasive the Internet is. Of course, even if some seniors don’t use the Internet, it’s likely others in their family do, so even non-Internet users may still be able to rate doctors and look up doctor ratings with the help of their family.

I found information in the December 2009 AARP magazine to be very encouraging. The AARP reported survey findings that 68 percent of people age 50-64 and 38 percent of people age 65 and over use the Internet to research information. That means there are plenty of seniors in a position to give their doctors feedback and to make use of DrScore ratings.

With time, those numbers will only increase. As the Internet becomes more pervasive, not only will the public make greater and greater use of DrScore, but more and more physicians will see the value in replacing “stone age” paper surveys with Internet-based collection of patient satisfaction information. 

Service at Great Wolf Lodge

During the recent holidays, we took our family to Great Wolf Lodge in Concord, N.C. The hotel houses a large water park, along with many other forms of entertainment for families. We had a wonderful, memorable experience.

The hotel was very nice, technically well run, with family-friendly rooms and clean, modern facilities throughout. There was ample parking. The water park had fun rides and plenty of clean, warm towels.

But beyond all that, the quality of the service made our experience at the hotel stand out. Throughout the hotel—from the doorman, to check in, to cleaning staff, to the water park guards, to the restaurant staff—there were “Hello’s” and “Thank you’s” that sounded heartfelt, as though the staff were welcoming us into their home and were truly happy to see us. I look forward to going back for a future visit.

A medical office can give patients the right diagnosis and the right treatment, but that alone isn’t enough. Patients deserve a medical experience that is friendly and caring, too. Medical care is hollow and even less effective when it misses adequate attention to either the technical or human aspects of the medical care experience. 

Information on Doctors

Many people come to DrScore.com to look up doctor ratings. Others use DrScore just to find lists of a particular kind of doctor in a particular area. I sometimes need to find a dermatologist or other medical specialist in another town for a patient I’m seeing. DrScore has been tremendously useful to me in those situations, helping me find a doctor, their address and contact information (not to mention patients’ satisfaction scores!).

Some people have correctly noted that the DrScore database isn’t fully up to date with accurate information on doctors’ practice information. It’s a difficult task to keep up with 800,000 doctors whose practices move, change, retire or start up. Our database will never be perfect, as the information is always evolving. Fortunately, there’s an easy way patients can help. If you see any information on DrScore that is out of date, please let us know by sending an e-mail to info@DrScore.com.

Preparing Our Annual Report Card

This is the time of year when the folks at DrScore.com revisit the data collected over the past year and put together our annual report card. Let me tell you what a great team of people we have doing this. It starts with Dr. Roger Anderson, the outstanding patient satisfaction survey scientist who developed DrScore’s interactive patient satisfaction survey. Then we have the team of programmers and statisticians who created the nuts and bolts that make DrScore work. Each year they put their expertise to the task of compiling and analyzing the data that you provide us. I have the most fun part of the job, reviewing the findings and determining what cool things we can learn about American medical care from our survey data. Be on the lookout. We’ll have this year’s report out in just a few weeks.

DrScore Helped Develop an App

Our DrScore team never ceases to amaze me, and as I look back at last year, I like to tick off a list of accomplishments and say thanks. Committed to the enhancement of patient care and the idea that patients can help doctors by giving feedback, our group has a terrific record of achievement.

• We put together a system that allows any patient, anywhere in the United States, to give their doctor feedback.
• We implemented an interactive online patient satisfaction survey that lets patients give doctors detailed feedback without taking much time to do it (and that was no small feat, marrying the interactive survey to a database of more than 800,000 doctors!).
• Recognizing the value to patients of patient advocacy groups, the DrScore team developed a means to target patient advocacy group information to patients based on the specialty of physician the patient searched out.
• Our sales and marketing team got doctors to sign on (thanks to forward-thinking doctors and health care administrators who realize the value of feedback and of transparency of their quality to the public).

The pace is not slowing down. We recently implemented the Spanish version of the survey to extend the accessibility of the survey to a wider audience. We continue to partner with other organizations that share our goal of enhancing patients’ medical care, and we have even partnered with webtalkradio to start an online health care radio podcast to complement the DrScore online doctor rating/patient satisfaction site (more on that later).

At the end of the  year, we partnered with Paladin Group and Castle Connolly to create an incredible iPhone application that will give iPhone users an easy way to find doctors. The new iPhone app will give users access to the DrScore ratings of the doctors and to Castle Connolly’s Top Doctor listings. Apple approved the app, and the ineedadoc app can be purchased directly from the iTunes store. Our development team did a phenomenal job interfacing with the Paladin group to make this project a reality. Kudos, team!