Archive for the ‘Find Safe and Decent Health Care’ Category

Guest Blog: Waiting Too Long for the Doctor? What to Do

Barbara Bronson Gray
Tuesday, May 1st, 2012

Barbara Bronson Gray, RN, MN is an award-winning writer and nationally-recognized health expert who blogs at bodboss.com. She has worked in hospitals, helped run hospitals, led a major healthcare magazine, wrote articles on healthcare for many national magazines and newspapers, developed a website for WebMD, served as a leader of global communications for biotech giant Amgen, and has a communications consultancy based in California.

“I wasted time, and now doth time waste me.” – William Shakespeare, Richard II

A friend recently asked me: Why do we have to wait so long for doctors and not for other professionals, like lawyers, accountants or dentists? And is there anything we can we do about it?

A 2009 study estimated that we spend 24 minutes waiting to see a health care provider.  I suspect new data would show that we are waiting much longer. As you might guess, overall satisfaction drops the longer we have to wait.

Waiting to see a physician is much, much different from waiting for an airplane or a bus.

You’re often anxious about the appointment, uncomfortable, in pain or worried. I have a friend who had to wait three hours for her first chemotherapy appointment, which seems cruel. Another friend had to wait almost an hour to get oral surgery: sitting in a cold office, having had no food or water since dinner time the night before, and very nervous.

Why Are You Kept Waiting? 

There are many different reasons why you may be kept waiting a long time.  While there is always the possibility of an emergency having caused an unusual delay, most practices seem pretty consistent; they either always keep you waiting or rarely make you wait. That’s due to the health care providers’ basic beliefs about their time and money; how much they value their patients’ time; and their ability to run a smooth and efficient practice.

A practice that doesn’t make you wait has undoubtedly made a decision that it’s not right to make patients sit very long in the waiting room. They respect your time as much as they respect their own. So they are careful to reserve a few slots every day in their schedule in case a patient’s visit takes longer than expected or there’s an emergency. They also create some “breathing time” in the schedule to help ensure the ebb and flow of people in and out won’t create a frustrating and tiring delay for their patients.

A practice that always makes you wait has a different perspective. They are typically maximizing revenue, over-booking multiple appointments to allow for some “no-shows,” and might even encourage extended patient visits and un-planned procedures because they increase the day’s revenue. Basically:

More Patients + More Procedures = More Practice and Personal Revenue.

Sometimes, the practice is just lax. I had the first appointment of the day to see my general practitioner and waited a very long hour. When I asked the office staff how that could possibly be and was there an emergency, they said, “Oh, no, she comes in when she comes in.” Hum.

Some of us mind all this more than others. A good friend of ours told me he has come to expect long waits when he or his wife sees a specialist. (He’s right. Average waiting times of specialists are longer than generalists). So he brings a big stack of back issues of the Financial Times and starts plowing through them.

What Can You Do?

Here are a few approaches you can take to deal with this issue:

  • Book the first appointment of the day or the first appointment after the office’s lunch period. This doesn’t always work because some practices book several people for every slot, but it’s worth a try and it’s likely to minimize your wait at least a bit.
  • Call ahead and ask how the day is going in terms of appointment delays and see if you should come in a little later. I’ve tried this with various results. Sometimes they just warn you that they’ll take you based on when you come through the door.
  • If you’re seeing a doctor who is prone to being called out of the office—a specialist such as an obstetrician/gynecologist or a surgeon—call ahead to see how the day is going. If you can reschedule on a bad day, you may save yourself a lot of time and aggravation.
  • After you’ve waited for 15 minutes or so (or whatever amount of time you’re personally comfortable with), ask the office staff how much longer they think the waiting time will be. If their answer doesn’t please you and if your problem doesn’t require immediate attention, ask to reschedule your appointment. Somehow that often gets you seen more quickly.
  • Consider talking frankly with your doctor or writing a letter explaining your frustration about the long waits and ask that the practice improve. See what happens.
  • Be a super patient patient. Bring fun things to do, read or listen to, and hunker down for the afternoon with an amazing attitude. (This would be very hard for me).

More dramatic options:

  • Complain about the waiting times on social media sites like Facebook or Twitter, or websites like Yelp or Angie’s List.
  • Find a new doctor. Ask the new practice’s staff what their philosophy of waiting times is before you book. Listen to what they say.
  • If you don’t want to keep seeing your doctor, you can sue your doctor in small claims court for your time. People have succeeded at this. It certainly makes a point.

The bottom line: Expecting me to wait a long time in a doctor’s office tells me two things. First, I don’t feel respected. The physician is, after all, my consultant. And secondly, I wonder how committed the practice is to my comfort and to reducing my anxiety when they seem to be putting more emphasis on their needs than on mine.

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Hospitals, Practice Administrators and Clinicians: You Gotta Learn to Love Patient Ratings

Jessie Gruman
Wednesday, April 25th, 2012

Jessie C. Gruman, PhD is president and founder of the non-profit organization Center for Advancing Health. Her experiences as a patient — having been diagnosed with five life threatening illnesses — informs her perspective as an author, advocate, and lead contributor to the Prepared Patient Forum blog. Her most recent book, AfterShock, helps patients navigate their way through the health care system following a serious or life-threatening diagnosis. You can follow her on Twitter at @JessieGruman. More…

You are increasingly being held accountable for the outcomes of the health care you deliver. Pay for performance; shared savings in ACOs; public report cards…the list of strategies to monitor and measure the effects of your efforts is lengthening. Many of you seem dismayed by the increased weight accorded to the patient experience of care ratings embedded in most of these programs.  Here’s why you should embrace them: The care you deliver cannot improve our health outcomes or even maintain passable ones without the knowledgeable, active participation of us patients and our families.

If we don’t connect with at least one trusted clinician, show up when we need to, get the tests we agree on, use effectively the drugs and devices you recommend, carefully follow directions after a hospital stay and try our damndest to lose the weight and walk around the block more often, medical interventions are squandered. Our suffering continues. Time and money are wasted: yours and ours.

Read the rest of this post at Health Affairs Blog

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More on…Patient Navigators and Talking to Your Pharmacist

Conversation Continues
Friday, April 20th, 2012

Conversation Continues feature ongoing discussions or news on current health topics with links to related materials.  They are part of the Center for Advancing Health’s portfolio of free, evidence-based coverage of what it takes to find good care and make the most of it. 

Two recent online posts build on topics we’ve explored previously on the Prepared Patient Forum. The first on finding and using patient navigators/advocates, the second on the value of working closely with your pharmacist.

On The Doctor Weighs In, Linda Alder, in Understanding Patient Advocates and Patient Navigators, explores the nuances between navigators and patient advocates. Linda notes that “The effort to engage and assist patients has been growing steadily over the last twenty years, and notable approaches have emerged to help patients increase their involvement in their medical care.  A couple of decades ago, research on geographic variation and subsequent variability in outcomes gave rise to Shared Decision Making, where patients were offered decision aides to help them learn about their diagnosis in order to make informed decisions in partnership with their medical providers. As personal computers have become ubiquitous, there has been the accompanying emergence of “e-patients”, where health consumers participate online to share experiences, offer advice and crowd source their data. Finally, propelled by current legislation and the emphasis on preventing hospital readmissions, we see the emergence of the “patient centered home”, where patients are the focus of the care plan.

It’s logical then, given the momentum, that there’s an interest in expanding the care team to provide professional expertise in assisting patients with the complexities of illness.” Click here for Linda’s full post.  See also Jessie Gruman’s Patient Navigators: Are They Necessary or Just Nice?

Patient Power’s Andrew Schorr reminds us to Don’t Hesitate to Ask Your Pharmacist! in a new video filmed at his local pharmacy.  Andrew shares the questions he thinks you should ask your pharmacists about your meds, side effects, etc. and remarks, “Pharmacists are among the most accessible of medical professionals, but sometimes we hesitate to consult with them about our medications, or we forget they are there to help. ”  For Andrew’s video click here.   For related posts see Jessie Gruman’s   Check Box Medicine …. and Herb Wells’ post: A Near Miss. A Good Pharmacist. A Serious Lesson.

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Guest Blog: A Second Opinion from Dr. Google

Carolyn Thomas
Monday, April 16th, 2012

Carolyn Thomas is a heart attack survivor and a 2008 graduate of the annual WomenHeart Science and Leadership Symposium at Mayo Clinic in Rochester, Minnesota – the first Canadian invited to attend this prestigious training event.  She was also named by “Our Bodies Ourselves” of Boston in 2009 as one of 20 inductees from seven countries acknowledged as “Women’s Health Heroes” for community activism in promoting women’s health.  You can read more from Carolyn on her two blogs: Heart Sisters and the Ethical Nag.

I’ve often suspected that if only the E.R. doctor who misdiagnosed me with indigestion had bothered to just Google my cardiac symptoms (chest pain, nausea, sweating and pain radiating down my left arm), he and Dr. Google would have almost immediately hit upon my correct diagnosis: myocardial infarction, or heart attack. But instead, he pronounced that I was “in the right demographic” for acid reflux. I was sent home that day feeling horribly embarrassed for having made a fuss over nothing but a case of indigestion. As time went by, however, and my debilitating symptoms became truly unbearable, I turned to Dr. Google.

And that’s why I forced myself, despite my embarrassment, to return to the E.R. – but with the pronouncement of that E.R. doc still ringing in my ears:

“It is NOT your heart!”

Many physicians out there, however, are not happy when their patients consult Dr. Google to research troubling symptoms like mine.

A female heart patient from Wisconsin, for example, shared recently:

“When I first began discussing my condition with my doctor, he said he hadn’t realized I was a doctor. I told him I’m not a doctor, but I am a very good researcher. He gave that small, insulting half-laugh that doctors reserve for this response and said that he wasn’t sure he approved of patients doing research.

“I told him I had no inclination to apologize for it. I said that I knew he was interested in my health, but not nearly as interested as I am.

“It’s his job, but it’s my life.”

Dr. Stuart Foxman of the College of Physicians and Surgeons of Ontario has written about doctors’ reaction to the growing phenomenon of patients who are self-educated “medical Googlers”. On his blog for physicians called DocTalk, he cited a survey of physicians that found many docs rate the know-it-all Googler as somewhere between “frustrating” and “irritating”.

This study noted a number of doctors’ concerns.  Some patients used the information gleaned on their own for self-diagnosis or self-treatment. Some doctors believed that the information caused the patient unnecessary confusion and distress. Dr. Foxman explained:

“All of these seem like legitimate concerns on the part of physicians. The highly curious and informed patients were sometimes perceived as ‘challenging’ with a tendency to test the knowledge of physicians. Some doctors felt that these patients were overly assertive, undermined their authority, and did not show sufficient trust in their health care provider.”

Consider, for example, Dr. Scott Haig‘s classic TIME magazine essay called ‘When The Patient Is A Googler’ - a scathingly arrogant attack that describes  his Googling patients as:

“. . . suspicious and distrustful, their pressured sentences bursting with misused, mispronounced words and half-baked ideas.”

Just a tad oversensitive to having his authority undermined, wouldn’t you say?

The reality, of course, is that, despite doctors like Haig, patients are indeed consulting Dr. Google in growing numbers.  According to the Pew Internet and American Life Project, 80% of us use the internet to “prepare for or recover from” our doctor visits.

Well-known physician blogger Dr. Kevin Pho believes that it’s time to stop debating whether or not patients should research their own symptoms.  It’s happening already, as he warns:

“The medical profession would be better served to handle this new reality.”

My heart sister Laura Haywood-Cory survived a heart attack at the age of 40, caused by Spontaneous Coronary Artery Dissection. She recently explained her own need to seek information and support online in her essay on the Stanford School of Medicine blog, Scope:

“As a patient with a rare condition that most cardiologists have never encountered, I and others like me have had to become our own experts. And since our numbers are small, we aren’t able to gather for support in person; we do it online.

It seems to me that the answer isn’t to discourage people from seeking medical information from Dr. Google, but rather to teach people, starting in school, some critical thinking skills. How to sift the online wheat from the chaff and how to determine which sites have credible information, versus ones that are just selling the latest formula of snake oil.”

Dr. Michael Lowenstein, co-director of the California-based Waismann Institute, believes that the more educated patients are about their health, the better care they’ll get. He also says patients need to be their own advocates in today’s health care environment. For example:

“There are patients who educate themselves and go to reputable websites that have good information. It makes for an intelligent dialogue between doctor and patient about the medical condition and treatment options.”

Since we know that many patients are already inclined to go online and search for information, physicians should look at this as an opportunity to enhance their own websites, warns Erin Sharaf of Northeastern University.

“It’s smart for medical practices to have a website and steer their patients to better resources. Refer them to other reputable external sites with links from your own website, so that patients know they are credible, respected and have accurate information. It’s also important to both stay up to date with the medical literature as well as the lay press so you know what your patients are reading.”

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