Listening to Patients

The University of Utah Hospital  on Oct. 10,  2016 in Salt Lake City. Dr. Vivian Lee's leadership the University of Utah was the first health system in the country to post patient experience scores -- and reviews of doctors -- online for the world to see. She also led the development of a first-of-its-kind tool to track and report the actual cost of caring for each patient that comes through the hospital and link it to the quality of their outcomes.  Photo by Kim Raff for Stat

You really need to read this story.  The title is called A health care revolution that starts with listening to patients  (the link is having some trouble) and it is a classic administrator shell game to placate the media as the system continues to break.  Here are some highlights:

  • Their quest is unfolding not in a lab or an operating room, but on the screen of an iPad that asks patients a straightforward question: What do you want from your care?
  • “That’s the holy grail for me,” said Dr. Vivian Lee, chief executive of the University of Utah Health Care system, a network of four hospitals, a cancer institute, and 10 neighborhood clinics. “Now we’re really going to start to define value in terms that matter to the patients.”
  • In late 2012, it became the first hospital system in the country to post unedited patient reviews of its physicians online. Right there, on the official hospital website, patients could, and did, accuse specific doctors of being rude, rushed, or always running late — and rank them on a five-star scale. (They also offered plenty of compliments.)
  • Two years later, Lee’s staff built a database the size of multiple football fields to track the health care system’s costs to the penny, another unheard-of step in an industry where most hospitals have only a vague notion of how much they actually spend to, say, replace a knee, or deliver a baby, or evaluate a patient rushed in with chest pains.
  • It’s not just apps. Health care innovation requires true communication. It is something Lee believes deeply. Her management style is to set goals and let her employees figure out how to reach them. And she embraces ideas from her staff, too.
  • The patient reviews grabbed plenty of national attention. But Lee said the decision to post them was the prelude to a more fundamental change. She wanted to shake up the relationship between the hospital’s doctors and patients, and make the cost of care a much bigger part of the equation.

So are they really listening to patients?   If they don’t fix the system by getting rid of the insurers and removing the bureaucratic drag placed on the doctors then all they are doing is moving crap around until the next crisis occurs.

Do doctors, in this industrialized model Lee works in, have time to listen to patients?  The article never said.  If the answer is no then all the other dog-and-pony show garbage they are doing is for show  (and to get Dr. Lee more notoriety as well as an increase in income).

 

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] 

  10 comments for “Listening to Patients

  1. Ken
    October 24, 2016 at 2:46 pm

    I wonder if Dr Lee and the other administrators allowed for the physicians to rate her/them and then published the results got all to see…

    • Ken
      October 24, 2016 at 2:47 pm

      *for all to see.*

  2. Pat
    October 22, 2016 at 8:16 pm

    This whole concept is garbage, and sets up the physician as the bad guy.

    Why aren’t the doctor’s asked as well, what do you want from the patient in order to care for them?
    1. Minimal whining
    2. Actually take the damn meds
    3. Throw the smokes away
    4. Reduce oral intake / increase physical output
    5. Convince me that you won’t sue me (trick question – not possible)
    6. Limit your list of miseries to one per visit.
    7. Accept that some mild daily discomfort comes with living (see #1)
    8. Don’t ask me to spend time getting prior authorizations for anything. You put others in charge of your care, not me.
    9. Expect me to prescribe what your formulary authorizes (see #8)
    10. Don’t complain about your bill. I’m only getting a small fraction of the payment, and I’m tired of hearing about it.

    Based on their answers and subsequent responses, how about “patient performance reviews”, posted publicly?

  3. LJSlossMD
    October 22, 2016 at 1:59 pm

    “By their Works shall ye know them”

    This is a pretty good job of talking the talk, and is possibly a start in a better direction. Stay tuned for the Works …

  4. LJSlossMD
    October 22, 2016 at 1:59 pm

    “By their Works shall ye know them”

    This is a oretty good job of talking the talk, and is possibly a start in a better direction. Stay tuned for the Works …

  5. October 22, 2016 at 10:10 am

    Properly, a primary care setting is a RELATIONSHIP between HUMAN BEINGS. This is being deliberately extinguished from the retail environment as inefficient and unprofitable.
    The current system is the equivalent of, say, Donald Trump writing a webpage calculator for rating your wife in fifty categories, from “burns the toast” to “flabby a**.” That way, you can give ol’ wife-ums the quarterly report on performance, and upgrade when the time comes.
    Some chicks wouldn’t dig it – but for sure, they’re not “10’s” baby!
    Fortunately, our culture recoils in horror from “wife performance objectives.” Why allow them in medicine?

  6. HJR
    October 22, 2016 at 9:14 am

    Bingo.

  7. Eugene Frank
    October 22, 2016 at 7:55 am

    As a 4score+ patient I look at evaluation sites when searching for a new specialist. Keeping on schedule is a negative attribute to me. I want a provider who will take the time needed to deal with my problem.

  8. Thomas Guastavino
    October 22, 2016 at 6:19 am

    If my patients answered honestly to the question, “What do you want from your care” only about half would say, “To get better”. Other answers would be:
    1) “To get my narcotics renewed”
    2)” Somewhere to go” (Lonely elderly)
    3)” Bigger work comp check”
    4) “Stay off work as long as possible”
    5) “Justify my disability claim”
    6) ” My lawyer told me to come in”
    So much for “patient satisfaction”

  9. Thomas Guastavino
    October 22, 2016 at 6:14 am

    If my patient population answered honestly to the question, “What do you want from your care” only about half would answer “to get better” Other typical answers would be:
    1) ” My Narcotics renewed”
    2) “Somewhere to go” (Lonely elderly-kind of sad really)
    3) “A bigger work comp check”
    4) “Keep me off work”
    5) “A bigger disability check”
    6) “My lawyer told me to come”
    Come to kind of it, I like this idea. Where do I sign up?

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