How do patients define quality medical care?


Category : Medical Rants

MACRA represents one “solution” to physician payment.  The idea seems admirable – pay physicians for providing high quality care.

Making a new framework for rewarding health care providers for giving better care not more just more care.

Rewarding quality seems to desirable.  Who really objects to rewarding quality?  But quality is a very non-specific word and concept.  Who defines quality?  What quality dimensions will we reward?  From whose viewpoint do we define quality measures?

Put another way, do the quality measures address patient concerns.  So I propose a thought experiment.  What do patients want from their physicians?  How do patients define quality medical care?

At the risk of hubris, I will offer some thoughts:

  1. Patients want a physician to listen carefully, look them in the eye, and address their concerns.
  2. Patients want correct diagnoses.
  3. Patients want to understand “the plan” – what is the diagnosis, what is the proposed treatment, what diagnostic tests are ordered and why
  4. Patients want access to their physician – timely appointments, email, text, phone calls – and do not want unnecessary visits scheduled
  5. Patients want to avoid medication side effects.
  6. Patients want cost considered when at all possible1

As we travel down the quality road, I would like to see patients interviewed and consulted about what defines quality.  I would bet that their concerns differ from current performance measures.

Like most physicians, I am a patient also.  When I have medical concerns, I consider the above attributes.

Please add to or subtract from this list.

Comments (3)

Finally, a logical set of suggestions, Dr C. But who is listening? I have gone a step further and asked patients how they would feel if I could not ethically continue to participate in Medicare after 2017. The responses are clear, not surprisingly. So I have my first Medicare Town Hall planned for this friday, to which elected officials are also invited. Here they will hear from my patients what they consider “quality of care” and why MACRA makes no sense. Perhaps the message will then find some ears.

Every physician I know would rather deal with the year end edge-of-the-cliff SGR negotiations than be subjected to the enormous administrative burdens that are included in MACRA. The interests of physicians and their patients were not (once again) well represented in making this sausage – another step in the corporate takeover of a once proud profession.

I can’t speak for other patients, but what I want is:

1. Clear two-way communication. (That would include carefully listening, addressing my concerns, making sure I understand the “plan”, etcetera. I don’t much care if you look me in the eye. I’m not totally comfortable with a lot of eye contact myself. *shrug* )

2. Consistent access.

3. Avoidance of all iatrogenic complications to the extent possible. (Not just medication side effects. I’d just as soon not get HIV from improperly sterilized medical equipment, a perforated bowel from invasive diagnostic tests, or influenza from a doctor who felt compelled to work while ill as well… And so on.)

4. An open mind about diagnosis and treatment. (That is, I understand that we might not get it right the first time because these things are complicated and some diagnoses are a bit fuzzy, but if something doesn’t seem right or the treatment isn’t working, I want my doctor to be willing to look again and consider other possibilities instead of just brushing me off as a crank.)

5. A feeling that we’re on the same team.

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