Posts Tagged providers

Communication Skills — you’re not listening

warning not listening

Laura Landro of the Wall Street Journal wrote an article “The Talking Cure” which appeared today (4/9/13).   She makes several good points:  1) 39% of patients feel doctors communicate poorly,  2) better communication improves health and reduces cost and  3)  there are ways to help doctors communicate more effectively.

These points are difficult for doctors to accept, especially the 39%.   Yet, the data is undeniable;  the oracle of Wall Street speaks truth.  Although, most physicians do not like to hear such comments from the lay media the message has been communicated well and with empathy.

Many years ago the Iowa Health System had doctors at one clinic participate in a communication study.   The patients were told that at the end of the clinic visit they would be given a test about what was wrong with them and what instructions they should follow.   A ton of bricks fell on the clinic.  The patients all had a pencil and paper and they would not let the doctors leave the exam room until the they had the answers to the impending quiz.  After all, the patients did not want the doctor to look bad.  The doctors tell the story of the experiment with fond memories and a feeling of gratitude for the lesson in communication.   The patients did pass their tests!

The Wall Street Journal article comments on the “4 habits” of good communication for health care providers:  1) create rapport  2) elicit patient views (and listen), 3) demonstrate empathy, and 4) assess patient ability to follow a treatment regimen.  It takes a lot of practice to think about the evidence-based practice-guidelines and simultaneously do those 4 things.

Doctors in training generally find video recording of patient interactions both  stressful and time consuming.   Video-based training takes time away from the operating room and clinic — but is that bad?   College communication majors become very comfortable with video training — they see themselves in the video recording and they use the sessions to hone communication skills.  Perhaps physician training programs should take a lesson from the department of communications.

Medical knowledge is a package within a wrapper.  That wrapper is communication skill which may be as important as the package itself.

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Rate Your Health Care Provider

The following rating system is intended for adult primary care office visits, but could also apply to some specialty visits.  There are no extra points for famous doctors, university clinics or the only provider in town.  Add up the points to see how your provider’s office is doing.

Performance Points
When I call the office, who answers?
 A real person 2
 A computer answering system that connects to a real person 1
I know the office will provide appointments:
New patient appointments within 3 weeks or
Follow-up appointment for new problem in 3 days
Urgent problem (during office hours) on same day 3
 The office designates time for walk-in visits  2
 The office has some evening and weekend hours  2
Moving through the office (assuming you were on time)
 Checked-in within 5 minutes 2
 Checked-in within 5 to 10 minutes 1
 Face to face with the provider
within 5 minutes of appointment time or
within 30 minutes for a walk-in visit
 Face to face with the provider
within 10 minutes of appointment time or
within 45 minutes for a walk-in visit
Checked-out within 5 minutes of leaving provider 2
Checked-out within 5 to 10 minutes of leaving provider 1
 Provider visit
 I do not have to take off clothes before seeing provider 2
 I can sit in a chair at eye level with the provider 2
 Provider seems to care about me 5
 I am not interrupted while I say the reasons for the visit 4
 The part of my body with problems is examined 3
 The paper chart or the computer is just used
by the provider to find information to help me
 The diagnosis of my problem is made clear 4
 I am directed to handouts or Internet sites about my problems 1
 Before I leave, the provider asks if I have any other questions 3
 It is clear when I need to return for recheck 3
 Medication Management:
 The reasons I need to take all medications are explained 3
 My provider sends prescriptions by computer 2
 Possible side effects of medications are discussed 1
 At each visit I receive a list of my active medications 3
 Tests (x-rays, blood tests, EKG, biopsies etc.)
If I need tests I am told why 2
 The office always lets me know test results within a week 2
 I always get copies of test results 2
 Practice environment
 My provider has associates who substitute when needed 2
 Hospital care is done by hospitalists 2
 My provider is part of a system including specialists 2
 Physician assistants or nurse practitioners work at the office 2


Score Rating
 60 and over  5 star
 50 to 59  4 star
 40 to 49  3 star
 30 to 39  2 star
 below 30  1 star

Hotels have struggled to get the coveted 5 star rating for decades.  It is not just whether the hotel chef can make a souffle but whether the whole experience of staying in the hotel is superior.   The items in the above score are considered elements of quality for health care delivery.  It’s not easy to get 5 stars.

Medical and surgical care has focused on diagnosis and treatment for hundreds of years.  To that end individual providers spend years, if not decades, honing diagnosis and treatment (some say, to a fault).   The vast majority of problems in primary care are fairly easy to diagnose (like diaper rash, acne and diabetes).  Treatment is harder because it spans time, is a process and requires patient engagement.  So, as it turns out, the wrapper may be as important as the package.  Providers are well trained and licensed but the wrapper of delivering care is where quality, safety, cost-effectiveness and satisfaction reside.

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