A Better Patient Experience
What was your experience like the last time you were referred to a specialist? Odds are pretty good it went something like this:
Your doctor says you need to see a cardiologist and recommends a guy he uses. You go home and fret for a week before the secretary at the cardiology office calls you to schedule your appointment. You arrive early and the nice lady at the front desk hands you a clipboard with a stack of papers—asking about insurance information, previous health conditions, and prescriptions—along with a pile of waivers and releases to be signed. When the doctor finally sees you he seems to have no clue why you’re there and knows nothing about your medical history. You’ve had some testing done elsewhere but he can’t readily access the results (the technophiles among you may be surprised to learn that the majority of data transmitted between physician offices occurs via fax—a technology that came into common use over 30 years ago). Eventually he suggests that you simply repeat the studies.
You finish the tests and wait by your phone to get the results. You hear nothing that evening, but the following day you come home from work to find a message on your answering machine: please call us. Of course, now it’s too late to call the doctor’s office, so you wait till the following morning. It turns out that one of the tests is mildly abnormal and the nurse tells you that a more invasive procedure is needed. She goes over it a bit on the phone and sets up a date.
You break the news to your family who, predictably, has a million questions, all of which you failed to think of when you were on the phone with the nurse. So, you call the office again but are unable to reach anyone who can give you satisfactory answers. “We’ll just have the doctor call you,” they say. Again, you wait by your phone and hear nothing.
The day before your test the doctor finally leaves a message on your machine. You get back in touch with him and get the answers you need. The test comes off without a hitch and you recover well. It turns out that your heart is actually healthy and you don’t need any further treatment. “What about diet, exercise, lifestyle changes?” you ask. The nurse hands you a brochure as they show you the door.
What if it went like this instead?
Your doctor says you need to see a cardiologist and recommends the group he uses. As you leave the office you simply give the receptionist your email address and head home to your computer. In your inbox you find an email from the cardiology group with a username and password to their secure site. You log on to find that you can not only review the details of the group’s members but you can also schedule an appointment over the internet without a phone call. You look over the biographies of the cardiologists and even have chance to watch a brief video of each as they explain their approach to medicine. You pick one who seems to suit your preferences and set up an appointment.
Next, you’re led through a questionnaire about your active symptoms and your past history. If your primary doctor’s office is internet savvy they have already forwarded your pertinent information (with your permission) in order simplify the process. You also have the option to download your medical history from internet repositories like Google Health.
When you show up to the appointment you find that the clipboard is nowhere to be seen—since you’ve provided all the information on the computer there’s nothing left to collect. When the doctor sees you he already knows your medical history and an outline of your current symptoms. He’s already seen the results of your previous tests so there’s no need to track them down or repeat them.
You come back for additional testing. When you first registered with the practice you selected the method of communication you’d most prefer from a list of possible approaches (phone call, email, text messaging, etc.). In keeping with your preferences you receive a text message on your phone the moment the doctor finishes interpreting your tests notifying you that the results are available at the website. You log on and read the report as well as the doctor’s recommendations. Because he feels you need further invasive testing he asks you to call to discuss it further and gives a direct phone number and a time to call.
The doctor talks you through the procedure and asks you to check your email for some web links. There you find an online video of the doctor again explaining the details of your test along with an option to email the link to your concerned family members. You also have the ability to type any additional questions you may have (of course, you can always call if you want). Within 24 hours you get a response to your query from a nurse who helps do the procedure.
The test is normal and you recover without difficulty, but instead of tossing you out of the office, the cardiology group asks your permission to keep in touch with you about educational items, healthy living courses, and sponsored activities. From then on you receive occasional emails aimed at improving your preventative health and offering you the option to contact them with any questions.
My suspicion is that most of you have never had the experience I just described. Why is that? Is it because the technology isn’t available? Hardly. Every day we shop, book airline flights, and handle our finances over the internet. I can sign up to get a text message on my phone if a plane flight is delayed or if a particular stock rises above a certain threshold. If everyone else can manage the technological hurdle, why can’t we?
One excuse I frequently hear is “privacy.” Administrators seem to be concerned about the security of medical information being communicated electronically. Hogwash, I say. Secure internet portals have been available for years—all it takes is a little effort to set up a system where patients can log on to a provider’s web site and gain access to their own information.
I think the real excuse is inertia. The medical community always seems to be decades behind the rest of the world when it comes to computerization and is just painfully slow to adopt the customer service smarts that the rest of the business world has.
In fairness I have to plug my own parent organization. CHI Health Clinic (CHC) has gone to great lengths to simplify and streamline the patient-care experience. You can sign up for a secure access that will allow you to request appointments with all the CHC doctors. CHI Health’s internet whizzes have even launched a system where some test results can be conveyed via secure email.
Before you see an CHC doctor you can also view a short bio-video on the internet. If you schedule an invasive procedure with one of our cardiologists you can watch a video of that doctor talking you through the nuts and bolts of the surgery. Your family members, especially those who don’t live in the area, will probably love this since it gives them a chance to enjoy a virtual visit with the very person who will be doing the procedure. With CHI Health you can also sign up to receive email updates about community health events and receive useful tips on how to stay well.
Someday, we in the medical world will make the most of available technology to truly simplify and improve interactions with our patients—something I eagerly await. I recognize that it is going to take several more years before my “ideal” patient experience becomes a reality.
But for now, I’d be satisfied if we can just find a way to forever ban the use of clipboards and fax machines.
Eric Van De Graaff, MD
M. Bloom, Thanks for pointing out an issue I struggle with every time I write a post about doctors (and patients, for that matter). When it comes to hypothetical narrative I have three ways I can handle the issue of gender: 1. Write he/she and him/her every time a pronoun is needed, as in "when you see your doctor he or she tells you that you have a brain cloud." 2. Use "they" in the singular form rather than "he" or "she," as in "when you see your doctor they tell you that you have a brain cloud." 3. Arbitrarily pick a gender. Each of these choices is distracting in some way or another, with number 1 being cumbersome and number 2 being grammatically incorrect. I typically go with number 3 and have tried to balance my choices of male and female pronouns over the course of more than a hundred blog posts. In this particular case I am highlighting what I consider the "stereotypical" patient experience in the world of specialty care, and in that world (as statistics would suggest) the doctor is usually male and the office receptionist is usually female. The statistics about primary care, on the other hand, favor having the doctor be famale. This is all changing, of course, as the make-up of the student body at most U.S. medical schools is becoming more and more populated by women and at some point in the future I'll be able to drop the male pronoun altogether. Having made the case in my defense I must now issue a mea culpa: in re-reading the current post I regretfully discover that in paragraph 7 I have made the primary care doctor a man as well. So, M. Bloom, you are correct in your assertion that I seem to be injecting some type of gender bias into my writing and I promise to work harder in the future to bring more balance to my blog posts. Thanks for your comments about an issue that I feel deserves due attention. Dr. VDG
I love the idea of this technology! As a person myself, who is a current patient (and former employee of cardiology)I know first hand the how a first impression can be for a new or current patient. A wonderful smile, and not having a patient fill out so many forms can be such a smooth transition for each and every patient. Not only does it save time for employee and patient, but it doesn't cause panic on the patient. If a patient does not have email, I think it would be very beneficial for a patient liasion to be able to bring them into the office to help fill out form, answer questions about financial responsibility and just ease their fears. We have them for patients coming into the hospital, why not for a physicians office. I know the receptionist can do some of this work, but coming into the office with several other patients can be hectic. Let's face it, we are talking about heart here, whether to fix our heart or to have a kind and talking person in matters of the heart is important.
I loved your description of this high-tech patient experience! While I was reading it, all I could think of was, "Wow, wouldn't that be AWESOME!" I think Alegent should create a panel that analyzes your ideas in this blog, and then works on implementing them. Although, I must say that Alegent has come leaps and bounds with being able to watch video interviews of doctors and videos explaining procedures. I think the idea of email and text messaging is amazing- that would revolutionize the face of health care, making for a more personal visit for each patient. Thanks for you blog! It is the highlight of the MyAlegent webpage (in my opinion)! God Bless, Hannah
Great description of "how it is" and "how it could be". There is no good excuse for health care not to be a better experience for the patient. Kudos to you and the Alegent IT and communications people for the great work that you have done on our webiste with the video introductions and procedure videos. Let's all work to make the process of patient communication better.
Nice story, but what is distracting is that all the doctors you mention are men, while the office helper lady is the only woman. Try being a little more gender-inclusive next time, as a lot of doctors are women.