Giving patient what they want and need
Our patients have
long laundry lists of concerns and issues when they come in for office
visits. This puts us behind in our day,
leading to complaints and stress.
This is a difficult situation. The patient’s wants and needs are not inappropriate. What is intrinsically wrong with a patient having all their questions answered and concerns addressed? Why is it wrong for a patient to have a long list of concerns? Of course there are individuals who talk forever and we can think of folks who would abuse any system established, but this is not the common condition. When we feel that an office policy is needed to restrict the excessive demands of the patients, we are at the cusp of erecting a barrier between our patients and the care they need.
The tension arises because the system is set up to make it nearly impossible to deliver on their wants and needs. Practices are on a hamster wheel, running as fast as they can to keep the revenue flowing. The typical scenario is a visit template based on 15 minute interactions and patients with multiple conditions/complaints/concerns as well as preventive needs. The unfortunate result is that we ask patients to prioritize their needs and sometime important issues are left unaddressed.
While many practices have improved their efficiency (defined in this case as “reducing the amount of time patients are waiting in the office to see the provider”) it is at the expense of patients. Patients have to overcome many obstacles to come to our offices:
In addition to the issues noted above, a nice study on Why We No-Show describes human ambivalence regarding a doctor visit – people may fear what could be discovered – “I’ll bet it’s cancer.”[1] For some people, some times, the fear or lack of interest prevents the person from following through and we have missed an opportunity for prevention or early diagnosis or intervention. This is likely one of the reasons behind the poor outcomes in primary care.[2]
The fundamental driver of this dysfunction is the deadly combination of high overhead and inadequate reimbursement for good primary care. Overhead is our problem to fix. We have examples of practices that have figured out how to radically reduce overhead to achieve patient-centered collaborative care.[3] We must explore ways of dramatically reducing overhead costs in larger practices while joining forces for payment reform.[4]
[1] Lacy,
N.,
[2] McGlynn,
E. A., Asch, S. M., Adams, J., Keesey, J., Hicks, J., DeCristofaro, A., et al.
(2003). The quality of health care delivered to adults in the
[3]
[4]
Bodenheimer, T. Primary care: Will it
survive?