A question for patients

17 Jun
2009

 

If physicians answer this question – please clarify that you are a physician.

When you consider physician quality, what attributes do you consider?

I would love several attributes from each reader.  I am considering writing an article on quality, and am asking for help in framing my comments.

 

Thanks in advance,

db

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9 Responses to A question for patients

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PhilM

June 17th, 2009 at 2:49 pm

Competency
In touch with the latest developments
Passion to heal
Compassion
Admit mistakes

From my childhood rheumatic fever episode leading to value problems to my royally screwed up hip surgery, my health care providers have failed me in various ways. It shocks me that most doctors I interact with are less aware of recent developments in their own specialty than an informed patient on a support group/forum.

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MmmBop

June 18th, 2009 at 5:13 am

PhilM-You have one diagnosis to keep up on the latest. Even the most narrowly specialized specialist has hundreds. And most of these ‘recent’ developments aren’t recent, aren’t developments, and aren’t useful, IMHO and experience.

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Clinton

June 18th, 2009 at 5:43 am

Consideration.

1) the doctor is considerate — not rude or disrespectful towards me or my opinions.
2) the doctor takes things into consideration — listens to my concerns and follows up with his/her own concerns and provides rational discourse on the best course of action, ensuring my own understanding in the process.

(MS-4 here. I believe the above comments illustrate the importance of consideration in the overall professionalism and quality we seek in our personal physicians.)

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docanon

June 18th, 2009 at 9:53 am

I am a physician.

The idea of a “quality physician” is fundamentally flawed at a conceptual level. There is no such thing as a “quality physician.”

However, there is such a thing as high-quality patient care, and patient care is delivered by a system. The appropriate conceptual unit of analysis when thinking about quality is the sum of all care delivered to a patient over a given period of time or episode of illness. Quality (which ultimately boils down to outcomes) is the product of a complex interplay between patients and the health care system with which they interact.

Attributing quality to physicians–either as individuals or as a class–betrays an unfortunate physician-centered view of the medical universe. It ignores the crucial contributions of other types of health care providers, and it demeans patients as passive recipients of care. It sounds like PhilM has had some illustrative experiences.

Put another way, no patient is guaranteed high-quality care by having a “high-quality physician.” Each physician is each good at some things and bad at others. Each has good days and bad days. Each is better at treating some types of patients, and worse at others. Any individual physician’s degree of influence over quality of care (measured at the appropriate conceptual level) is actually rather small, and as much as one exists, a “high-quality health care system” is one that is as robust as possible to undesirable physician actions that cannot be reduced to zero (e.g., diagnostic errors, memory lapses in routine tasks).

It is fine to talk about the desirable characteristics of physicians, and patients provide an invaluable perspective on these. When I am a patient, I like a kind, knowledgeable, and professional caregiver as much as anybody else, and ceteris paribus, I would expect such a physician to make, on average, a small but meaningful contribution to the quality of care I receive.

But it would be misleading to define “high quality care” as any care that is received from a “high quality physician”…if that’s where you were going. Too often I fear that discussions of “physician quality” by physician commentators make this implicit assumption.

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Jan Krouwer

June 18th, 2009 at 12:53 pm

1. Unbiased treatment advice
2. Physician knows more than I do

An ideal treatment is (at least in concept) effective with minimal side effects – cost is not an issue for insured patients. Yet, some physicians steer patients towards a treatment that may not be ideal for that patient – prostate cancer is one example. This leads to people using the internet and other sources to be their own patient advocate. Whereas it would be silly to think such research makes one competent, it is not good if one gets the feeling the doctor is not as knowledgeable as the patient.

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Dave Moelling

June 18th, 2009 at 3:31 pm

I want the Doc to treat me like an adult and an intelligent client who is part of the decision management. Maybe I come at this from a different direction as an engineer who does troubleshooting consulation for heavy industry so I do my own form of diagnosis, prognosis and treatement recommendations to my clients.

I like it when the MD takes 1 minute of the visit to explain their decision making process to me. If you are confident enough to lay this out before your client then you have it under control (and if your not sure then the additional investigations follow some path). It can be a simple as “when we see this, this and this (and not this) it indicates disease A. The treatment B does x, y and z to alleviate it.” Also make sure I understand the major variables so I don’t get sidetracked worrying about small stuff. (I know you deal with trial lawyers, but you don’t have to lay down in total fear of them).

MOST Importantly!!! If you are the first/primary physician try to impose some continuity on the process. If you send me off to a surgeon, tell me to come back to see you to close the loop. There was a reason you sent me there in the first place.

There is nothing more common, or more frustrating than having each specialist make unnecessary and uncoordianted comments to the patient who has no idea how to make sense of them all.

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Lisa Kilburn

June 18th, 2009 at 3:47 pm

As a patient I look for two main qualities in a physician.

One, I want my encounter with the physician to make me better. More specifically, I want a timely, accurate diagnosis and I want the prescribed treatment to return me a full health. As side note, the prescribed treatment has to be implementable in terms of finances, lifestyle, and avoidance of side effects. For example, the MD/naturopath who told me to totally cut sugar out of my diet may have been right that that would relieve my various physical ailments. However, I did not feel it was a treatment plan I could follow.

Two, the physician has to have good interpersonal and communication skills. I want a physician who can provide an atmosphere for honest communication. I want to know what the treatment is, how long it will take to work, how it will affect my life while I am taking it, and under what circumstances should I seek further medical care.

The challenge, unfortunately, is figuring out how to find a physician who exemplifies those characteristics. Many people ask for recommendations from friends and acquaintances. Unfortunately I have found that nine times out of ten, the doctor that patients love is no longer accepting new patients. Another method is to find a board certified physician. Again, they are rarely accepting new patients. Generally I have had to choose a physician based on nothing more than a name in the phone book or in the list of preferred physicians for my insurance company. The good news for physicians is that I will stay with that physician unless they give me reason to leave.

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Theresa

June 20th, 2009 at 1:42 am

I have to respectfully disagree with “docanon.” As a patient, I do not receive care from a “system” – it comes from a human being who has studied medicine. I hire a physician to obtain his opinion which is based upon his formal medical studies and his experience. The greater the medical studies and experience, the higher the “quality” of the physician’s opinion. In addition, a quality physician is one who takes the TIME to really and truly listen to patients complains and persists until he/she has solved the issues.

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docanon

June 23rd, 2009 at 2:07 pm

@Theresa-

As a physician I love having my ego stroked. I love the idea that I exert a determinative influence over the quality of care my patients receive. I love the idea that because I am smart, finished a highly competitive residency program, and studied my ass off, my patients will now benefit from my labors. What a rush.

But such a scenario does not reflect reality. As a participant in the most flawed and complex service delivery system in existence, I am acutely aware of the limits of my power to affect the care delivered to my patients.

Sure, you hire a doctor for an opinion. Does that doctor then draw your blood? Walk it to the lab? Run the machines? Examine the slides? Dispense the medicines? Determine the behavior of other doctors and countless other providers who constitute the sharp edge of medical service delivery? No. She does not.

Like it or not, your health care is delivered by a system. Each individual providing services can have good and humane qualities, or bad and maladaptive ones. Patients–myself included–value these qualities, and these qualities are already being measured in surveys of patient experience. Every rational member of the quality improvement community already knows that patient experience is related to, but distinct from, other measures of health care quality. This doesn’t mean that the human elements you value aren’t important. But it does mean that they present an incomplete picture of the quality of care that you receive.

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