Patients routinely treated disrespectfully?
Carolyn Marsh of the Picker Institute said that patients and their families are often forced to push hard to extract information about the patient’s own condition and prognosis from doctors who are unwilling to be forthcoming with that information on their own. Marsh illustrated the point by describing the recent experience of a gravely ill, elderly patient in New York. The patient, Marsh recounted, “was very well known in New York.” Despite the patient’s prominence, and despite having paid for “the best doctors,” information about his condition “was withheld from [him] and his wife in too many instances, right up to his death.”
According to Marsh, “both he and his wife were anxious to know as much about his illness as possible, and almost no one made an attempt to keep them in the loop.”
Regardless of the motivation of the doctors, Marsh said, the result was that they failed to meet what she called the “duty is to respond to questions with complete answers that will allow patients and/or their families to understand fully the scope of the situation.” The patient’s widow was left “with needlessly bitter memories of the whole sad experience.”
Taking responsibility: individual and systemic issues
No one Remapping Debate spoke with failed to emphasize systemic deficiencies in the way medical care is delivered as a primary driver of the problems discussed in this article. Nevertheless, some experts we spoke to insisted that doctors have a personal level of responsibility to see that patients are treated with respect.
patient “rounding” — a missing element of basic courtesy and respect?
The white paper from Press Ganey referenced in this article recommends a process it calls “patient rounding.”
“After a patient has waited 15 minutes (and every subsequent 15 minutes), a staff member should physically get up and walk into the waiting area. The staff should acknowledge that the patient is still waiting, provide an update about when the visit is expected to begin and ask the patient if there is anything that they need to be more comfortable. This directly addresses patient cognitive and socio-emotional needs.”
This is a recommendation that does not address the underlying problem of long wait times, but is intended encourage medical practices and providers to show they are not indifferent to the value of the value of the patient’s time or to the concerns that may arise in the patient’s mind while he or she is waiting.
Remapping Debate would like to know more about the extent to which this courtesy is or is not provided and why. Please contact us with your thoughts and observations.
“If it’s an ongoing pattern [of lateness],” Chou said, “Then it is the doctor’s responsibility. You can’t just say, ‘That’s just how things are with me, I’m always running late.’ That’s a professionalism issue on behalf of the doctor.”
Elizabeth Rider echoed Chou’s sentiment; “If we just behave like technicians,” she said, “then we’re not professionals.” She added, “Paying close attention to the patient and understanding the patient’s perspective is an important piece of medical professionalism and ethics.”
Furthermore, Chou noted the difficulty in getting physicians to understand the importance of treating the whole patient, rather than just a list of symptoms, saying, “All this medical knowledge has been stuffed into our brains, so that we have this huge fund to be able to trade on when we go see patients. Everybody’s focused on data for patient outcomes. Traditionally, we’ve been a lot less focused on what the patient’s needs and values are.”
In the end, though, Rider and Chou agreed with other experts about the need for systemic change. Yale’s Fortin, for example, said, “I know that we don’t [make patients wait] on purpose, but in primary care remuneration per appointment is low and overhead is incredibly high, so that appointments need to be short to keep the income flow in the black.”
Fortin identified systemic change as the only sure way to solve the problem of long wait times, saying, “Perhaps if our current healthcare non-system gets reformed, overhead costs will go down, primary care doctors will be adequately compensated for their expertise, and we can book fewer visits per hour, and be of more help to the patient, without chronically running late.”
Chou also blamed the structure of the health care system for the kind of problems described in this article, saying, “I almost always hear that doctors do want to spend more time with their patients. This is exactly why many run late, especially if the scheduling is out of their control; in some institutions, doctors are expected to see primary care patients in 12 to 15 minutes.” When asked, however, whether it’s reasonable for patients to feel disrespected of that their time isn’t valued when faced with exorbitant wait times, Chou said, “I fully agree. It’s really not fair for patients to have to wait to try to get in.” He added, however, “It is often the prevailing system that prevents doctors and patient from achieving what both generally want, which is more time with each other.”
Fortin echoed the sentiment that doctors want more time with patients as much as patients want more time with doctors, adding, “Doctors feel that they are running at full speed all day. No one likes to be apologizing every day, but that’s what we wind up doing.”