Posts Tagged ‘Patient Dissatisfaction’

Prostate Cancer Screening: Are we supposed to be screened or not?

Wednesday, March 3rd, 2010
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By Evan Falchuk

The American Cancer Society says that men over 50 need to seriously consider whether they really ought to get screened for prostate cancer.  According to them, the risks of getting tested may outweigh the benefits of detecting the cancer, especially for younger men.  They say it’s a “complex issue,” but they understate how complicated it really is.

Like the recent controversy over breast cancer screening, the new recommendations add to the swirling morass of conflicting messages and priorities around health care in America.

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Doctors are People, Too, Ctd.

Wednesday, January 13th, 2010
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By Evan Falchuk

A new study out of Israel (h/t Robin Grantham via twitter) says that the kind of mood your doctor is in may significantly impact the quality of care you get.

On days the doctors felt positive moods, they spoke more to patients, wrote fewer prescriptions, ordered fewer tests and issued fewer referrals. However, when doctors were in a bad mood, they did the opposite.

Now, I bet this is true in any line of work.  If you’re in a bad mood one day you probably aren’t as good at your job as on days you are in a good mood.  Ok, well maybe not every line of work.

Still, if being in a bad mood leads to lower quality, higher cost medicine, let’s think about what the work life of a doctor typically looks like.

For starters, they often have to see 30 or 40 patients a day, and spend maybe 20 minutes with each.  Private insurers and the government impose on them an increasing amount of administrative work.  They’re also increasingly involved in the medical decisions the doctor works so hard to make.  Doctors’ incomes aren’t going up, but the cost of their malpractice coverage is.  Meanwhile, patients are increasingly demanding and sophisticated, the pace of change in diagnosis and treatment is accelerating.

It’s a set-up that seems exquisitely designed to create high levels of stress, anxiety, fatigue and burn-out, doesn’t it?

Of course, these were precisely the things the Israeli researchers said led to lower quality, higher-cost medicine.

The stress, anxiety, fatigue and burn-out we see, though, are just symptoms of a larger problem.  Our system too often deprives doctors of the time and space they need to get to know a patient, think about their problem, consult with colleagues, and offer sound advice.  These are the things patients want from their doctors.  What’s more, doing these things are a big part of why people become doctors in the first place.  Unfortunately, there isn’t much of anything in the health care reform proposals that addresses this deeply fundamental problem, and so it will continue, or get worse.

Which ought to create bit more stress and anxiety for the rest of us.

http://twitter.com/RobinGrantham

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Posted in Doctor Patient Relationship, Healthcare Reform, Quality Care | View Comments

The Hardest Word

Wednesday, November 25th, 2009
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By Evan Falchuk

Dr. Toni Brayer asks – is it dangerous for doctors to say “sorry?”

In the past, physicians were advised to never admit to a problem or to apologize for clinical errors with the thought that it would lead to more lawsuits. Saying “I’m sorry” might be taken by a lawyer as an admission of guilt and malpractice. Attorneys advised, “Say nothing” but that left patients with unanswered questions and often the feeling that the doctor just didn’t care.

She points out that some 35 states have passed laws that prevent a doctor’s apology from being used against him or her in proving a malpractice claim.

I understand why these kinds of laws may be needed.  If you say you’re sorry for something, you are implicitly taking some degree of responsibility for whatever has happened.  Plaintiff’s lawyers will use a doctor’s apology to the maximum extent possible to show the doctor knew what they did was wrong.

“Sorry” is, as wise people have observed, the hardest word in the English language.  But why is this?

I think people like to think of themselves not as infallible in their actions but as infallible in their intentions. By this I mean, whatever I do, it will be with the right intentions.  Even if something goes wrong, it will not be so much my fault so much as a bad twist of fate.  Apologizing is, in this sense, a very un-natural thing to do.  You haven’t done anything wrong.

But think of it from the perspective of the person who has been harmed by your actions.  If you’ve hurt me in some way, I may conclude that the reason it happened wasn’t dumb luck but rather that you were careless, or at the least not concerned enough with my well-being.  Your failure to apologize will look to me like my conclusions are right.  You can’t even say you’re sorry?  You must not care much about me at all.

It’s enough to make someone very angry.  And it’s awfully easy for an angry person to find a lawyer who will listen to them.  At that point, it’s too late for sorry.

Saying you’re sorry is so hard because it takes so much humility.  We have to be willing to accept that not only are we imperfect in our actions, but we can also be imperfect in our intentions.  Or at least that others may believe we are imperfect in our intentions.  You have to be able to admit that, yes, it’s true, I wasn’t as attentive as I could have been.  Or you know, you’re right, I can see why you would think I was being careless, I’m sorry for what I did.

So long as your apology is genuine, timely, and based on a true understanding of the problem you have caused, you will defuse the problem.  But your work isn’t done.  Apologizing doesn’t fix everything, it just gives you the opportunity to repair your relationship.  So, saying sorry is not a cure for problems of medical malpractice, but it might prevent more cases than you think.

Still, there is something very wrong with the notion that we need to pass laws to make it so that an apology isn’t a legally dangerous thing to do.  We should not look upon a doctor’s apology as something to be used against him, but rather as a sign of his humility and his caring for his fellow man.

If he has committed malpractice, there will be plenty of facts that can demonstrate it.  Whether he acted as a good and caring person in dealing with the aftermath of a bad event ought not be one of them.

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Posted in Doctor Patient Relationship, Patients, Physician Perspectives | View Comments

Why Reform is Going So Badly, Continued

Thursday, August 13th, 2009
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By Evan Falchuk

As I’ve blogged about before (here, here, here and here), a big reason reform is going so badly is this:  Reformers don’t understand how people react when you try to make changes to their health benefits.

Companies across America have been making changes to health benefits for years.

Reformers seem to have ignored the lessons of their experience.

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Posted in Health Insurance, Healthcare Benefits, Healthcare Reform | View Comments

New “Patients for a Moment” is Up

Wednesday, August 12th, 2009
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By Evan Falchuk

The 5th edition of the health blogosphere’s most interesting new carnival, Patients for a Moment, is up at Adventures of a Funky Heart.

If you don’t know, Patients for a Moment is the brain child of blogger Duncan Cross, and is the blog carnival “for, by and about” patients.

This week’s edition has a slew of great posts, go on over and check them out.

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Denying Illness

Friday, August 7th, 2009
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By Evan Falchuk

At the Well blog, Tara Parker Pope links to a provocative piece by Dr. Pauline Chen on what happens when a diagnosis is missed.

Dr. Chen writes about a patient that had found a small mass on her breast.  Ignoring her doctor’s advice to start the process of properly diagnosing and treating it, she decided to try alternative therapies.  It wasn’t until the tumor had become “the size of a young child’s head” that the patient became worried enough to visit Dr. Chen and have surgery to remove it.

In her piece, Dr. Chen wonders about issues in our care delivery system that lead people to miss out on getting the right care.  But I think cases like Dr. Chen’s patient are of an entirely different kind.  They’re suffering not just from the effects of disease, but also another, more common problem, denial.

I remember my father, who is an internist, telling me stories like the one Dr. Chen tells.  These were people with obvious, visible effects of a disease, but who weren’t getting any care.  It wasn’t that they had no one paying attention to them – often they had family and friends almost begging them to go and get help.  They just refused to go.

It is a reaction that I think is common to anyone who has suffered from a serious illness.  You don’t want the bad thing to be happening, it’s much easier to deny its existence.  The thinking is: I don’t want to be sick.  If I need medical treatment, then that means I’m sick.  So I will not seek medical treatment.

It’s much worse if the family of the patient is in on it, too, enabling the denial.  And I’m sure it’s devastating to those family members who want to see their loved one get help, but can’t get them to listen.

It seems like it’s very hard for doctors, too.

Dr. Chen is right to point to ways in which our system can do better at reminding people of the importance of following up on their doctor’s recommendations.  But the problem she is talking about is much deeper and fundamental to the human psyche than any change in the process of delivering care may be able to ever address.

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Doctors: Your Patients Are Talking About You

Tuesday, July 28th, 2009
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By Evan Falchuk

Attention doctors:

Your patients are talking about you.

They tell their friends, family and co-workers about you.  They talk about you in public places where people they don’t know might overhear them.  Probably every doctor understands this.  But for some reason, once all this talking starts happening on the internet, some doctors do odd things.  Like trying to get patients to sign “gag orders” before agreeing to treat them.

It’s a mistake, and a missed opportunity.

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Posted in Doctor Patient Relationship, Doctors beating the odds, Healthcare Reform, Quality Care, Some People Don't Get the Interwebs | View Comments

My Reaction to “Putting Patients First”

Tuesday, July 21st, 2009
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By Evan Falchuk

A blogger at the event put it simply: As bad as it is being sick, there are many things in our system that make it worse.

All of the clinicians who spoke at the event understood this, and talked about ways to improve the doctor-patient relationship.

But the problem is worse than the clinicians may think, and it’s not something health care reformers are talking about.

Let me share some data with you so you can see what I mean.

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Mutual Assured Destruction: Not the Answer to Med Mal Crisis

Monday, June 8th, 2009
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By Evan Falchuk

Doctors have a right to be mad about medical malpractice claims against them.

Is there a creative solution to this mess in an old tenet of nuclear deterrence?  What if doctors aggressively went after patients who sued them, and pre-emptively warned them about even complaining on the internet about their experience?

On the surface it sounds attractive.  The doctor lets his patients know the rules of the game: I do my best, and you agree that if things don’t work out, you won’t turn on me.  But a closer look reveals how destructive it is.

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Posted in Doctor Patient Relationship, Health Care Media, Physician Perspectives, Some People Don't Get the Interwebs | View Comments

It’s Not the Government – Everyone’s At It

Monday, May 18th, 2009
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By Evan Falchuk

Writing about health care reform, Peggy Noonan complains of the decay of the English language:

A reporter asked a few clear and direct questions: What is President Obama’s health plan, how would it work, what would it look like?  I leaned forward.  Finally I would understand.  [Secretary of Health and Human Services Kathleen] Sebelius began to answer in that dead and deadening governmental language that does not reveal or clarify, but instead wraps legitimate queries in clouds of words and sends them our way.  I think I heard “accessing affordable quality health care,” “single payer plan vis-a-vis private multiparty insurers” and “key component of quality improvement.”  . . . . As she spoke, I attempted a sort of simultaneous translation.  . . . But I gave up.  Then a thought crossed my mind: Maybe we’re supposed to give up!  Maybe we’re supposed to be struck dumb, hypnotized by words and phrases that are aimed not at making things clearer but making them obscure and impenetrable.  Maybe we’re not supposed to understand.

Noonan is on to something, but it’s not what she thinks.  What she’s hearing is real-life language of our health care system from the people in charge of it.   And it’s not just government officials who talk this way — Sebelius’ language is just as common in the private sector.

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Posted in Doctor Patient Relationship, Healthcare Reform, Quality Care | View Comments

  • "Medicine is learned by the bedside and not in the class room. Let not your conception of manifestations of disease come from work heard in the lecture room or read from the book: see and then research, compare and control. But see first."
    - Sir William Osler, MD
    The Father of Modern Medicine

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