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Patients Are Crazy

July 13, 2009 8 comments

.. or at least one of the people I follow on Twitter says we patients are crazy.  You can see his post here:

peoplearecrazy

My reply to him was that he shouldn’t be so surprised that a patient wants to review a second opinion.  Let’s look at point of view:

Suppose your car is making a horrible noise.  You take it to the mechanic who tells you your engine needs to be replaced.  Knowing what that will cost, not to mention that fact that it means your car will be out of commission for — oh — three weeks — while the engine is replaced, you take it to a second mechanic.

The second mechanic tells you that you don’t need a new engine.  You really only need to replace the belts.  That will cost you (money, time, grief) only a fraction of what replacing the engine will cost.

Now what? What if Mechanic #1 is right?  But, what if Mechanic #2 is right?  How are you supposed to know?  Do you need a third opinion?

If you trust Mechanic #1 (because, remember, trust and the expectation that he is 100% right 100% of the time are two different things) then it requires a further conversation with Mechanic #1. You need to know why he’s recommending the engine be replaced and why he doesn’t  think simple replacement of the belts is enough. You have additional questions, and you are confident Mechanic #1 can answer them.

And that is what your patients want to know.  They need a way to compare the two opinions they have received.  They need to know how you arrived at your recommendation. If they return to you, they do so because they trust you.  They just need to understand it better.

Put another way — what if it was you or your child? What if you had a difficult decision to make that would affect your child’s health and two people had told you two different things.  How are you supposed to figure out all the important details?

Patients aren’t crazy — they just don’t know the protocol.  They don’t understand reimbursements.  They don’t understand that you can only bill them if they show up in the office for the conversation.  They don’t get that you aren’t interested in donating your time to them.

But if you treat them as if they are crazy, they will never get it.

How to get beyond that hump?  Invite them in to discuss — through a billable appointment.

Your patient needs only a simple explanation.  “Mrs. Jones.  Dr. FirstOpinion would be happy to discuss this with you, but we’ll need to make an appointment to do that. Can you come in Thursday at 2 PM?”  Then, when Mrs. Jones arrives, explain to her that her payer requires an appointment be made to discuss options.  If she is puzzled, explain how reimbursement works.

We patients need all the information we can get.  And we need your respect for our information gathering efforts.  We want to collaborate with you, looking to you as our #1 resource for the information that will help us make difficult medical decisions.

Patients aren’t crazy.  We just need to learn. And we want to learn from people we trust.  Like you.

*Note:  Please see PediatricInc’s response to this post

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Learn more about Trisha and her work.

Learn more about Trisha’s book
You Bet Your Life! The 10 Mistakes Every Patient Makes

(How to Fix Them to Get the Healthcare You Deserve)

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"Putting Patients First" = No Patients (Time to go clean my room now.)

July 12, 2009 10 comments

I’ve just returned after being away for the weekend and logged into Twitter, where I find my favorite Tweeps discussing a Blogger-Politician-Healthcare Reform discussion being promoted by Dr. Val of Better Health, and some real dissention in the ranks regarding whether patients should be included in the discussion.

The doctors say “No, we can discuss what is good for patients.  Patients don’t need to be at the table.”

The patients, feeling very excluded, say, “How can you discuss what is best for us without asking us?  We are supposedly the focus of your conversation. Isn’t our contribution important?”

And the doctors reply, “We know what is best for you.  After all, we are all patients.  You are, therefore, represented.”

And Trisha says, “Not so fast!”

And here’s why.  In my attempt to help frame a conversation, to collaborate, to help you understand a patient’s point of view, please bear with me for a moment.

In the midst of healthcare reform, the word “collaboration” gets tossed around by those who think they want to collaborate. But the moment they must truly step up to the collaboration table, they opt out.  Why?  Not because they don’t want to, but because they don’t know how.  This seems to be a perfect example.

When you became a doctor, or a nurse, or whatever other medical profession you are part of, you studied medicine. But you also had mentors – attendings or higher level residents or nurse supervisors — someone who had been around longer than you — who taught you how to behave with patients.  Not treat them.  Behave with them.

You learned that you are in charge.  You call the shots.  You determine what is best.  You have the knowledge, education and experience, after all.

You behave with your patients not so differently from the way you behave with your children. Because you are in charge of them, and know what is best for them, too, right?

Think of it this way.  In your experience, and the reason you learned to behave with patients the way you do, is because you know that patients have not traditionally been good about taking responsibility for their health or healthcare.  (Your children have not been good about it either.) Therefore, for many, their health could not improve or be managed unless you DID care for them in that paternalistic, benevolent manner.  (Unless you insist your children clean their rooms, their rooms will never be clean!)

Not only that, it’s what your patients have expected.  (Kids know you’ll be upset if they don’t get their rooms cleaned.)

The problem is, that the healthcare world has changed.  I don’t have to tell you that.  You know that in many ways better than most patients do.

Included in that change has been a major shift in how patients see their care.  Many of us — those of us who have learned to take responsibility, and unfortunately, those of us who have learned that responsibility is necessary because of MAJOR hiccups with our healthcare — no longer want you to be or ask you to be so paternalistic.

We don’t want mommy or daddy doctor determining our care or “raising” us through our care.  We need you to help us be responsible patients.  We want to collaborate with you. Less parenting and more insistence on patient responsibility is what’s in order here.

And so we say to you — please stop telling us what is best for us.  Teach us to learn about our options and let us help decide what is best for us. Help us learn to be responsible.

We are not your children.  We are your colleagues, friends, customers, clients…. we are your patients.  We have opinions.  We have knowledge.  We are smart. We can understand. We can make decisions. We can become responsible.

But not if we are consistently excluded from the conversation.  Not if you only ever talk ABOUT us and not WITH us.  Not if you continue approaching your jobs as if you are parents, and not collaborators, even though — yes — I understand that you mostly can’t help that.  It’s how you were taught.

You are not a (pure) patient, too.  You are one half of a team. Professional and patient, together, will improve outcomes and attitudes for all.

I’m pretty good at keeping my room clean.  I can be a good collaborator, too.

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Learn more about Trisha and her work.

Learn more about Trisha’s book
You Bet Your Life! The 10 Mistakes Every Patient Makes

(How to Fix Them to Get the Healthcare You Deserve)