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Doctor-patient relationship: A meaningful marriage

Posted Jun 06 2013 9:33am

by Anthony Cirillo

I recently returned from a trip to Ireland where we visited my wife's cousin, Father Sean, a Catholic priest in Northern Ireland. He is a great soul with a wonderful sense of humor. During the course of our many conversations, we asked him how he spent most of his time. His answer--hatchin, matchin, dispatchin!

Hatchin meant the sacrament of Baptism for newborns. Matchin meant the sacrament of Matrimony. And dispatchin alluded to the funerals he performs.

Of course that got me thinking about patient experience! (Really, you say!)

Think about it. Before the emphasis on patient experience, value-based purchasing and HCAHPS chasing, healthcare providers were getting the experience of care right on both ends of the life spectrum--living and dying. We tackled the birth experience through the amenity pathway and backed into the more systemic issues over time. And hospice care providers were innovators in the experience movement well before it became fashionable.

Let's move on to the "matchin" part. Of course, for Father Sean that was about marrying people, the ultimate relationship. For the purposes of this article, I'd like to think about it as the marrying of the provider/physician relationship to the consumer. As two recent JAMA studies showed, we have a long way to go.

In one study, a survey of almost 22,000 admitted patients at the University of Chicago Medical Center found patient preference to participate in decision-making concerning their care was associated with a longer length of stay and higher total hospitalization costs.

The second study in the same publication examined a national survey sample of adults who had discussions with their physicians in the preceding two years about common medical tests, medications and procedures. The conclusion: The discussions often did not reflect a high level of shared decision-making.

You can read my related blog post on the implications of these two studies. Suffice it to say, shared-decision making is a much talked about but little achieved phenomenon, and when it does occur it costs the healthcare system more money. It is hard to build meaningful relationships that way.

Here's a dose of reality that perhaps can bring home the importance of meaningful relationships between provider and patient.

At a Memorial Day party, we were talking to a friend about healthcare and he related some experiences with his primary care physicians (plural). He recounted a trip to his physician in which mid-way to the appointment the office called and said it would have to reschedule because of some conflict the physician had. Our friend, being understandable, turned his car around and went back to his business.

The next day he showed up at the physician's office and waited and waited and waited in an exam room. He finally came out and asked where the physician was. The staff told him he was on the way. In fact, he wasn't even in the building!

Our friend got dressed, went to the reception desk and told the receptionist to verbatim tell his physician--"He's fired!"

A few hours later, the physician called our friend and tried to laugh the incident away. He was told again--"You're fired." Our friend explained to the physician that picking a physician is not so different that hiring an auto mechanic, a lawyer and an accountant. You are willing to pay for value and you expect it to be delivered. When it is not, you shop around.

Well, shop he did. Our friend called a physician he had heard about whose word-of-mouth on the street was good. He made an appointment and told the receptionist he would pay the visit fee but to make it crystal clear he was coming to the office to interview the physician before he "hired" him.

I thought this was a fantastic story and one you will probably find repeated over and over again. I fired a physician a few years ago then "hired" a new one. In fact, I liked him so much that when he relocated his practice 30 minutes farther away, I followed him there.

This is the new world providers should take stock of, particularly as uncharacteristic players like Wal-Mart enter the primary care arena.

Anthony Cirillo, FACHE, ABC, is president of Fast Forward Consulting , which specializes in experience management and strategic marketing for healthcare facilities. He also is the expert guide in Assisted Living for .

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