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Posts Tagged ‘patient responsibility’

I received an e-mail invitation to attend a medical-legal seminar on reducing risks. I’m not sure what they are going to cover, but clearly, the No. 1 way to reduce medical legal risks is for doctors to give patients great quality medical care. Patients also need to perceive the quality of care is great. That is why obtaining feedback from a patient satisfaction survey service like DrScore is a necessary component to assessing and assuring patient satisfaction.

Great medical care is really a partnership. Patients can reduce their risk of being in the kind of situation that results in medico-legal liability by taking more responsibility for their own care. Patients should get a copy of their medical records, particularly the results of laboratory work that is done. That will help make certain nothing falls through the cracks in a system that has shown itself to have too many cracks.

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President Obama appointed Dr. Donald Berwick to be the administrator of The Centers for Medicare & Medicaid Services (CMS) through a recess appointment that avoided a Congressional hearing.

Who is Donald Berwick? I’ve been hearing about him for years. He founded and led the Institute for Healthcare Improvement (IHI), a not-for-profit organization that has been pioneering efforts to improve of health care in the United States and elsewhere. His efforts have helped steer the U.S. health care system toward a greater recognition of the need to achieve health care excellence and, more importantly, have resulted in real, practical successes that have improved the care we receive in the U.S. health care system.

Some of Berwick’s detractors with respect to this appointment focus on statements he has made about rationing care and redistributing it to the people who need it most. Let me be very clear: health care will be rationed. It already is now, and the only question facing us as we try to address the spiraling cost of care is who will do the rationing in the future. Will we Americans choose to take responsibility to do it ourselves (by taking more responsibility for directly paying the cost of care), or will we leave it to insurers, politicians and other government regulators to do it for us?

So far it seems we don’t have the stomach to ration care ourselves, though I believe that increasing personal responsibility is the best way to control health care expenditures. If we are going to leave it to the government to control our health care costs, we could do a lot worse than having Don Berwick at the helm.

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Campaign finance legislation failed to pass the Senate today.  Last year, U.S. Senators Chuck Grassley (R-IA) and Herb Kohl (D-WI) introduced legislation to require drug companies to publicly report money they give to doctors over $100 every year.

This is a wonderful idea. Greater transparency helps everyone.  At DrScore, this is a focus of our beliefs about U.S. medicine. Doctors have nothing to fear and much to gain from transparency, whether we talk about patient satisfaction scores or pharmaceutical company support. The last thing we doctors need to do is to raise suspicions by fighting efforts to improve transparency.

In fact, physicians should lead the way in support of more transparency.  Not only should we be supporting the Grassley/Kohl measure, but  we should encourage Congress to expand the measure to include payments to politicians and their campaign funds.  Senator Grassley hit the nail on the head when he said, “The goal of our legislation is to lay it all out, make the information available for everyone to see, and let people make their own judgments about what the relationships mean or don’t mean.  If something’s wrong, then exposure will help to correct it.  Like Justice Brandeis said almost a century ago, ‘sunshine is the best disinfectant.’”

This applies to both physicians and politicians.  I hope we find that politicians are as ethical as physicians are.  If so, the public will be well served.

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On Getting Better Health Care, physician Cynthia Koelker, M.D., describes practical ways people can lower their health care costs right now.

Koelker is author of the book 101 Ways to Save Money on Health Care.

We don’t need government to legislate health care reform to lower costs if we take some personal responsibility. Click here to listen to the show.

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DrScore.com is a great way for patients to give feedback and to look up doctor ratings. But there are more traditional ways to assess and assure doctor quality: board certification. I discuss board certification with Dr. Kevin Weiss, president and CEO of the American Board of Medical Specialties on Getting Better Health Care. You can find out whether your doctor is board certified at http://abms.org/.


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Analyses of the patient satisfaction ratings on DrScore.com shows an extraordinary relationship between how caring the patient thinks the doctor is and how satisfied the patient is with the visit. How caring the patient thinks the doctor is accounts for nearly all the variation in doctors’ patient satisfactions scores far more often than other factors such as how long the patient waits in the waiting room or even how much time the doctor spends with the patient.

Notice I didn’t say there was an extraordinary relationship between how caring the doctor is and how satisfied the patient is. What matters is how caring the patient thinks the doctor is. That doesn’t mean the doctor doesn’t have to be caring. But in addition to being caring, doctors need to make sure patients know the doctor is caring.

I’ve yet to personally know a doctor who wasn’t caring. But doctors don’t always appear caring. I’m a test tube scientist, a nerd who isn’t naturally touchy feely, comfortable with hugging or interpersonally warm. While I care deeply about my patients, it might not always be obvious. Many doctors are probably like this, working incredibly hard to make sure they give patients great care, but not automatically appearing caring to all their patients.

Leaving just a few patients unsure about whether the doctor cares or not can ruin a doctor’s overall patient satisfaction score (at least compared to other doctors). As I mentioned in a recent blog, getting just a few 0s or 1s from patients can lower a doctor from having a score among the highest doctors (say a 9.8 or 9.9) to a score among the bottom half of doctors (say a 9.1 or 9.0).

Giving every patient the right diagnosis and the best treatment isn’t enough. It is absolutely critical that patients know the doctor is caring. Great medical care isn’t just about the right diagnosis and the right treatment. Touching patients, eye contact, body language — it’s all important.

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In my last blog, I pointed out that doctors’ overall patient satisfaction scores are very dependent on how often patients are completely dissatisfied. Even if there are only a few highly dissatisfied patients, it can lower a doctor’s patient satisfaction score considerably. And that’s the least of the problems with unhappy patients.

Leaving patients feeling uncared for and dissatisfied increases doctors’ risk of being sued for malpractice. These unhappy patients may also share their poor experiences with their friends, hurting the doctor’s (and all doctors’) reputation.

Worse yet, these dissatisfied patients are at risk for having poor outcomes. Poor outcomes leave patients angry and disappointed, and leaving patients angry and disappointed results in patients having poor outcomes. I think this is probably because these patients are less likely to use their medications. Since our goal as physicians is to get patients well, we also need to make sure our patients are satisfied with their care.

But the biggest problem of all with having unhappy patients is: having unhappy patients. We didn’t spend all those years in training because we don’t care about our patients. We care deeply about them. If they aren’t happy, neither are we.

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