Posts Tagged health care provider

Good & Bad Patient Portals — improving communication

patientportalA good patient portal is wonderful; a bad patient portal is a waste of time.  A recent post by Dr. Yul Ejnes suggested portals may not be patient centered and don’t get much use.

An alternative view is that all patient portals NOT are the same.  Some have great features and are supported by the providers offering them.  Other portals are not much more than advertising — generally something a patient does not revisit.  Sadly, many businesses have the latter type of portal — no wonder people don’t flock to medical portals.

Check out your health care provider’s portal.  If it does not really provide a benefit then TELL THE PROVIDER, complain, and say other providers do a better job.

Admittedly, a poorly functioning provider office will likely have a poorly functioning portal.  Just because the portal lets you send a message to the nurse or provider is no guarantee the response will be helpful.

Large vertically integrated health systems or ACOs have the best chance of a good patient portal.  The portal needs monitoring and rules for providers — rules that require questions to be answered the same day.  And, that the portal will display lab results within 48 hours, regardless of whether the provider has or has not seen the results.  Responses from nurses need to be monitored for accuracy and timeliness — the lazy but profitable response to just make an appointment is not adequate.  Integration of pharmacy functions is essential.

Here is a checklist of possible portal features — how does your provider’s portal stack up?

  • Responses to online requests take less than 24 hours
  • Ask a medical question
  • Ask medication related question
  • Make a follow up appointment
  • Make a same day urgent care appointment
  • Get refills on a chronic medication
  • Get a message from your provider about test results
  • Report drug side effects or drug allergies
  • Send a picture of a skin rash.
  • Diabetics can send blood sugar results
  • Asthmatics can send peak-flow measurements
  • Look at your list of medical diagnoses both active and inactive
  • See a list of current medications and the diagnosis for which they are prescribed
  • Links to drug information about the drugs on the medication list
  • Review the providers notes
  • Review any test, x-ray or consultation report
  • Your provider can send questions to specialists and forward the response to you
  • You can print your lab, pathology and x-ray reports
  • See your most recent medical summary including past medical history, social history, family history, medications list allergies — and be able to print the report if needed for consultations or to take on trips.
  • Request a summary of billing and payment information  — including when bills are sent to insurance and when payment is received.
  • Pay your bills on-line
  • Links to reliable on-line information sources about tests, treatments, drugs, immunizations and diseases.  Include a symptom checker — a computerized diagnosis based on symptoms — something to discuss with your doctor.
  • Provider office provides training to use the portal.

A provider might say:  “I’m not paid for running a portal or answering questions”.  That is very true for many providers in the US health care system.  But, in systems without fee-for-service billing then portals are a huge driver of efficiency.  If a patient’s questions or problems can be resolved via the portal so much the better for both the provider and the patient.  The handwriting is on the wall — fee for service is going to go away — the efficiency of portals will be a strong driving force.

 

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I’m Sorry — difficult for doctors

sorrybearSaying “sorry” is the human thing to do.  Doctors and nurses should say it when they feel it.

Saying “sorry” seems to have two meanings:  1) something bad happened and I understand your emotions  2) something bad happened and I had some connection with the event for which I feel partly responsible.  Bad things do happen in health care but “sorry” is a very uncommon utterance for health care providers.

Dr. Abigail Zuger writing in the New York Times 7/14/14 “Saying Sorry, but for What?” compared how she felt about a plumber who broke a valve in her house with medical personnel who broke other things —  neither said “sorry.”  Sorry truly does not fix anything;  but, the absence of “sorry” is infuriating.

The problem is ego.  Ego infuses some health care providers with the notion bad things are an act of God but good things are an act of ME.   Absence of “sorry” is a sure sign of defense (a defense of self).  Perhaps the health care provider was spanked as a child or yelled at by teachers.  Who knows … ego has gone wild.

Quality health care depends on people believing errors are due to system failures.  When providers fail to embrace that philosophy they fail to correct problems.  No failure, no correction.

A fall in the hospital can be deadly.  Recently, a family member fell in a room while no nurse was present and they died.  The nurse did not say “sorry.”  There was no acknowledgement of responsibility.   No acknowledgement the system was at fault, no realization there was a better way, and no reason to prevent future deaths.  The simple statement “sorry, I wish I had been there to stop the fall, we will investigate this to help others” would be the right thing to say, and believe.

Lawyers are not the cause of excessive health care ego.  However, lawyers with the threat of suit are a convenient excuse.  When bad things happen honesty and caring are much more likely to assuage the displeasure of a family than stonewalling.

 

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Getting Satisfaction

OK, patients are not satisfied with many provider visits.    Some people just avoid health care or just complain about it.  Consider that mummies have been found who had serious health problems during life.  Is that what we want, a postmortem in a thousand years? — “yep, he didn’t get good care”.

It is  not the patient’s job to make health care give satisfaction, but that may be what is necessary while we wait for system changes.   And yet, many patients currently walk away from a provider visit, the hospital or outpatient surgery feeling satisfied with the care and satisfied their questions were answered.  How did they do it?  What did they say?  Were they just lucky to have the “right” provider?   Getting satisfaction currently involves being proactive, doing your homework and speaking up.  Those who do are getting some degree of satisfaction.

First, understand the cycle each health care provider works in.

The “agenda” for the visit is made in step #1.   Make a list of 3 things you want to get accomplished during the visit and keep the list in hand.   Be assertive with the list right after the greeting “Just so I don’t forget I made a list of things I need today: 1)____ 2) ____ 3) ____”.  For example, this might be “review my stomach pains,  would a specialist help, get prescription refills”.  ABSOLUTELY do not wait until step #5 with these questions.  Make sure all items were answered by step #3 — if not, look at the list and repeat the items not addressed.

Make step #2 easy.  Have an up to date history in hand including past illness, past surgery, current medications and allergies.

Make step #3 understandable.  Before the visit research the symptom or known diagnosis on the Internet (like http://www.mayoclinic.com).  So when the situation is discussed you have some basis for questions, and ASK THEM.

Make step #4 interactive.  As each action is listed if you don’t know what it is (like CBC or CT scan) then  speak up “what is that and what will it tell us”.   If a procedure or surgery is suggested make sure to understand the top 2 risks and what the provider and you can do to reduce the risk.  And, what are the alternatives — understand the alternative of not doing the surgery or procedure.  Understand how you will get test results (make it clear you want the result as soon as  available whether  “normal” or not).

An informed and engaged patient will ask the above questions.  Many patients ask such questions.  Don’t be demanding, just persistent.  Give the provider a chance to do the right thing since most really want to please patients.  And, give the provider a second chance.  If there is a problem with the plan or medications discovered later, call the provider’s office for clarification.  But, repeated failure to respond to these simple questions means it is time to find another provider.

Sometimes people just can’t think clearly knowing a shot, pelvic exam, or prostate check are going to be done.  Thinking during a health care visit is essential.  So, if there are bothersome aspects to a certain visit ask to have those things done at a separate visit (yes it is more trouble for you but at least you can discuss problems intelligently).

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