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Where Does the Patient Fit in the Medical System?

Healthcare Needs to Treat Patients More Like Customers
Cathy Yeulet/123RF.com

As a physician, access to healthcare had always been a relatively easy task. I would chat with one of my colleagues in the ICU or operating room and get some names of which physicians would be best for the situation. Many times I could bump into them making rounds and get a bedside consult. If needed, it was easy to get an appointment in their office. No problem.

After I retired and moved to another town, I was still a physician, but no longer had easy access to the medical system. I had the full experience of what everyone else goes through: picking up the phone and attempting to make an appointment with a physician.

One unique experience I encountered was a dark reality that made me sit down to consider where the patient really is in the hierarchy of the medical system. I dialed the number to a pain specialist, and there was just an answering machine telling me to leave a message. As part of this message, it was noted that it could take up to 72 hours to get a call back. It also told me not to call again because it could cause further delays. In other words, I was essentially having to make an appointment with the scheduler to get on the physician’s schedule. I attempted to make an appointment with several other pain physician offices and was met with similar circumstances. Luckily for me, an ex-colleague of mine had moved to the area a month prior; I called his office and was seen within 5 days.

This situation made me realize that the patient is nowhere near the top of the medical system set up to take care of him or her.  As I was reading the Feb 27, 2018 JAMA (Journal of the American Medical Association), I came across a Forum article by David Cutler PhD. The statistics he gave help us focus on one of the problems. In general, medicine has 22 times more non-physician and non-dentist workers as physicians and dentists. In a physician’s office there are an average of 5.8 non-physician workers for each physician. There is a significant number of people not involved in direct patient care.

A physician is surrounded by all these people, yet talking to a person when you call for an appointment is not a guarantee.  A patient knows that she probably will have a significant waiting period to actually see the physician, but waiting up to 72 hours just to talk to a scheduler is completely unacceptable.

This brings to mind something you should add to your list when considering a job move or a post-retirement move to a community. You should check to see what it takes to make an appointment for basic and advanced medical care. Is the system so over loaded that you can’t even talk to a scheduler? Are they accepting any new patients, including Medicare patients? This information is also vital if you are taking a new job. Will you be so many patients behind when you start that the job consumes you?  Investigate. Some circumstances make it almost impossible for the patient to be the most important piece of the medical puzzle. If it takes 72 hours to talk to a scheduler and then 6-8 weeks to see the physician, the patient seems superfluous to the system.

In the healthcare system we currently have in the US and from the patient’s point of view, the order of importance is 1) stockholders (profit) 2) administrators/insurance companies (profit) 3) physicians 4) allied personnel and 5) the patient. I find this to be amazing because the most efficient and successful methods of healthcare delivery have the patient first. The healthcare workers have the most job satisfaction when the patient is first. The focus needs to be on a pleasant initial patient contact, waiting times, efficient information systems that can talk to each other, concise communication, and easy access to ancillary services, such as lab draws and radiology services. Any business discussion/decision would lead with how it affects the patient.

In most businesses, profit comes after you deliver a superior product to a customer. This rarely holds true in healthcare. The patient is the customer in a medical system. Usually the customer can vote by spending or not spending their dollars on a business or a product. This is not true for most patients. Changing healthcare providers is very difficult and at times impossible. Healthcare is clearly a business. In this business, the customer (patient) has little say about the success of the business in the normal sense. Most of the change for poorly treated patients comes from the staff within an institution. The business or job is to take care of patients. Recruiting healthcare workers into a chaotic, non-patient centered environment is very difficult. The thought process should be in a straight line, from the patient to treatment.

If you are changing practices or retiring from practice, check to see where the patient is in the order of importance in your proposed new community. If the patient is first, you will be a lot more satisfied.

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About Jack Isler, MD

Jack Isler, MD, practiced Critical Care Medicine and was an Anesthesiologist for 33 years. A large focus of his practice was on nutrition in the critically ill (Master's in Nutrition).

Books:

  • 21 Broken Bones, A Self-help Guide for the Chronic Pain Patient
  • Marijuana: It's an Herb with an Asterisk
  • Personal blog: “21brokenbones”---a blog on new pain relief therapies

Dr. Isler is currently writing a book on brain death, op-ed articles, and guest blog posts.

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