What Do Patients Value?

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The question of what do patients value is a very simple.   They value a caring, educated, well-trained physician who gives them time to hear their concerns.   Obviously, they care about more than that but that was a start.   Other issues may include good parking, a nice and clean building, friendly staff and the ability to see their own doctor.  Those are just basic business service principles and have been around for centuries or more.  To me, these all fit in with Direct Primary Care.  In the present model, time-constrained docs are burned out and lose their compassion.   They have no time for their patients as they rush to see more and more of them.   They have become RoboDocs who stare at a computer more than the patient.  The staff are also overburdened and sometimes come off rude.  When this happens, “broken windows” don’t get fixed and the little things slip in the office.  There is a syringe cap on the floor, a dirty room never gets cleaned or there are no clean gowns to put on the patients.

Now, that is my opinion and my agenda (supporting DPC even though I don’t do it).  What happens when you have another agenda?  Well, you create a study trying to show that a PCMH (Patient Centered Medical Home) is what patients want.   If you have ever read this blog then you would know that I hate made-up terms that do nothing.   You cannot tell me the old family docs didn’t have a Patient Centered Medical Home.  They would have laughed at the notion that it even needed a label.  But back to my story.  A recent study titled “Effects of Patient-Centered Medical Home Attributes on Patients’ Perceptions of Quality in Federally Supported Health Centers” just came out and the idiots at the AAFP were all over it.   First of all, a “federally supported health center” is NOT representative of real life but I will let that slide.   Here is what the found when interviewing about 5000 patients:

Research Highlights

  • 83.5 percent of patients reported excellent or very good overall quality of services,
  • 81.3 percent reported excellent or very good quality of physician advice and treatment, and
  • 84.3 percent said they were very likely to refer friends and relatives to the health care site.

Furthermore, PCMH attributes related to access to care and communication were associated with a greater likelihood of patients reporting high-quality care.

“These high patient ratings among health centers are especially remarkable given that low-income and uninsured patients across the United States generally rate their care much lower,” wrote the authors.

“Clinicians seeking to improve their patients’ overall perceptions of health care experiences should focus on improving patients’ experiences in getting access to care before and during the visit and on promoting clinician and support staff communication skills,” authors concluded.

Bottom line, what patients who participated in this study valued the most was access to and communication with their physicians and other health care professionals

So, here is my takeaway…….no shit!  Yes, patients want to get in to see their doctors and want more time (communication) with their doctors.  The present system, no matter what this study says, does not allow for it.   Part of the problem type of research is that 95 percent of the interviews were conducted at health centers when patients were visiting for a health appointment.  So, they in essence they were selected out as the ones who got access.   What about all the other patients who couldn’t get in?  Would they rate the PCMH so high?

The title of the linked AAFP article above is  called Patients Value Physicians Access, Communication Offered in PCMH Model but that really isn’t the conclusion.  That is the AAFP spin.  Patients value the things I mentioned in my opening paragraph and that has NEVER changed and never will.  Just because the AAFP wants you to believe the PCMH is the only way to do it doesn’t mean we should believe them.  In fact, I still believe the opposite is true.  The present healthcare model cannot deliver these values and it will only get worse no matter what pipe dreams come out of medical schools, the government, the medical residencies, the AAFP, the tooth fairy, MSNBC, etc.

Douglas Farrago MD

Douglas Farrago MD is a full-time practicing family doc in Forest, Va. He started Forest Direct Primary Care where he takes no insurance and bills patients a monthly fee. He is board certified in the specialty of Family Practice. He is the inventor of a product called the Knee Saver which is currently in the Baseball Hall of Fame. The Knee Saver and its knock-offs are worn by many major league baseball catchers. He is also the inventor of the CryoHelmet used by athletes for head injuries as well as migraine sufferers. Dr. Farrago is the author of four books, two of which are the top two most popular DPC books. From 2001 – 2011, Dr. Farrago was the editor and creator of the Placebo Journal which ran for 10 full years. Described as the Mad Magazine for doctors, he and the Placebo Journal were featured in the Washington Post, US News and World Report, the AP, and the NY Times. Dr. Farrago is also the editor of the blog Authentic Medicine which was born out of concern about where the direction of healthcare is heading and the belief that the wrong people are in charge. This blog has been going daily for more than 15 years Article about Dr. Farrago in Doximity Email Dr. Farrago – [email protected] 

  5 comments for “What Do Patients Value?

  1. Pat
    January 11, 2014 at 11:00 pm

    The lead author of the study works for HHS, i.e. the federal government, which has the goal of pushing PCMH’s. So a federal stooge is paid to study a federally funded institution and -Voila! – just happens to find results favorable to the underlying federal government goals, which will then be parroted by organizations (AAFP) dependent on indirect federal funding.

    What a sorry-ass, rigged game.

  2. Sir-Lance-a-Lot
    January 11, 2014 at 10:12 am

    ‘Round here, most of the pcp’s will refuse to see a patient if s/he’s a few minutes late, even for a minor thing like a BP check, will fire a pt. if s/he no-shows two appointments (which includes “appointments” with the lab for blood draws), and have about a 6-8 week wait for new patient visits. They also will not see patients for anything to do with procedures or acute injuries.

    That’s called “driving your patients away in droves.”

    I’m working Urgent Care now. Our patients love us (and tell us so every day). Why? Because we SEE them. When they’re sick. No matter what’s wrong with them. Right away(-ish).

    It’s great to confabulate about the (very real) terrible problems with the health care system on a macro level, but it’s completely screwed up on our very own little micro level, too, which is what that study is trying (unsuccessfully) to get at.

    • Ken
      January 11, 2014 at 12:51 pm

      Regarding your comments: Late patients, especially the first one of the day or afternoon, screw up an entire schedule and can cause a physician to have to rush through his other patients, phone calls, emails, prior-auths, etc., or go home late and spend less time with his family.
      6-8 week wait for new patient appts indicate the physicians in your area are over-worked, and have panel sizes that are too large. I really doubt they enjoy having to tell new patients their first appointment are going to be so far ahead.
      I’m extremely grateful for urgent care physicians, they are an invaluable asset and extremely under-rated. However they exist and prosper because of inadequate numbers of primary care physicians, many of whom are burned out and have to make hard decisions at times to keep their practice manageable. These physicians are not the enemy.

      • Sir Lance-a-lot
        January 11, 2014 at 1:05 pm

        Yes, Ken, you’re right. There aren’t enough of them and their panels are too large.
        They’re also forced by tough “productivity” contracts to pack in as many patients as possible and to run over those who might derail their schedules, in order to make a buck.

        In the “old” world, a primary doctor’s office would leave a few holes in the schedule for acutes and for those who unexpectedly require more time, but the folks around here are required to book their entire day back to back, in order to just be able to keep their heads above the water (or so I am told).

        And, yes, the dearth of primary docs is the reason for the existence of urgent care.
        Urgent care is a crappy, half-assed patch on a rotten, failing system, and should never exist at all in a system that paid its docs decently and allowed them to schedule their days reasonably.

        I, for one, would be delighted if the system were to change in a way that put urgent care out of business, but that’s never going to happen in the US. Instead, as pcp’s get more and more bogged down with paperwork and requirements, patients will continue to go to them for their regularly scheduled “continuing care,” but will be completely excluded from seeing them for any unexpected illness, injury, or question, and urgent cares will prosper and multiply, like fungus on the bark of a dying tree.

        • Ken
          January 12, 2014 at 12:04 pm

          “Like fungus on the bark of a dying tree.”
          That’s quite good!

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