Hospitals WANT Guitar Hero Healthcare

"Hospitals want involved patients" - from the Chicago Tribune.

Good piece, but a bit outdated.

The Joint Commission's Speak Up! Program has been around for a few years (at least since I used it as a Patient Advocate 'rounding' in 2003-2004), but you rarely see a specific staff person within the acute care setting responsible for implementing the program.

Our hospital, however, had a team of 5 Patient Advocates rounding on inpatient floors discussing the Speak Up! Program with patients and families.

What, we found, however, upon administering the program is indicative of the healthcare system's larger 'chronic' issues....

The process looked a bit like this:

1. PA enters the room, cheerily confirms identity with double checks (name, armband) - after asking if we can chat about the program and if the patient would like privacy while we do so.

2. Hands patient or family member/friend/caregiver/partner Speak Up! brochure while we give the pitch, usually multitasking and wiping staff board, refilling water pitcher at bedside, etc. Some people don't want the paper or the pitch, so PA asks if any other questions or any assistance we can provide.

3. Asks if patient has any questions or if we can be of assistance. 9 times out of 10 answer is resounding "yes" and issue is NOT related to Speak Up! program but medical care continuity (ie are my labs in yet? When will I be discharged? Who is my new nurse? What's for lunch?)

4. Chase down medical staff (nurse, tech, or in VERY rare cases doc) if it's a medical issue. Otherwise repeat we are 'only' PAs and not qualified to give medical information, but we have feet, and lungs, and can thus chase down and corner medical staff who can give correct info. (This would be why I wore sneakers, Nike Prestos, to work).

5. Bug caregiving staff incessantly if big issue, deliver message and confirm 'report' handoff verbally (and usually in my notebook with time and staff name cited in case I later had to do a variance).

6. Return to patient room and report progress on issue/contact resolution. Deliver sunshine and a smile (or 50).

Final findings from a year spent as a Patient Advocate:

1. Patients want to be involved. (10-80-10 rule: 10 percent unwilling/inable to self-advocate and be participatory, 10 percent hyperengaged, Guitar hero healthcare types, and middle 80 percent may be involved at varying levels).

2. Family members want to be involved.

3. Many doctors don't know how to treat patients who are verbally self-advocating...but if someone whips out a notebook and starts taking notes during the conversation they're on best behavior.

4. Communication between docs and nurses is often FUBAR. The blame baton is passed back and forth like care delivery communication is a contact sport. The rest of us, including patients, are relegated to acting as befuddled spectators.

5. Top issues of concern to patients are related to the 3 Cs: cure, care, communication.

Every initiative that purports to encourage increasing 'guitar hero healthcare' or 'patient involvement' must take systemic deficiencies in addressing the 3Cs into account. To ignore any of them is to court systemic failure.

Right now Ted Eytan is continuing to push on the most complete, viable definition of Health 2.0 for consumer-centric, patient-directed care advocates. Take a look. It's important work.

Until we can define 'involved' patients at a basic level, hospitals will have a hard time connecting idealistic goals to real strategic planning.

Patient involvement, CONSUMER involvement, is a vital component to figuring out 'what's next' for Health 2.0, and beyond.

Yesterday I sat in a nearly empty room at HIMSS DC Summit 2008 watching Jay Parkinson present the first truly consumer-centric GP practice model (here's some WSJ coverage).

Jay's new practice, Hello Health, is opening it's first storefront July 1st in NYC. Pay attention policymakers, hospital execs - the future of healthcare is closer than you think.

How to Pick a Doc - Masked Sources Tell All in New York Magazine

The following entry is comprised of commentary based on the article "What's Up Docs? A panel of anonymous physicians cough up tricks of the trade" by Robert Kolker, published in New York Magazine's "Best Doctors 2007" issue.

The premise is brilliant - a panel of five docs spill the beans on how to pick a doc, get an appointment with a specialist (pray???), and why wait times resemble Dante's trip to the inferno.

Click here to read the article, published today. (Thanks SenorBuck for the link).

The New York Magazine recruited the following docs to act as sources:

Dr. Lung . . . . . .Pulmonologist
Dr. Heart1 . . . . .Cardiologist
Dr. Heart2 . . . . .Cardiologist
Dr. Virus . . . . . . Infectious Diseases
Dr. Baby . . . . . . .OB/GYN

Some highlights:

• Always Bring a Family Member/Friend to Act as Personal Patient Advocate: Dr. Baby relates a horror story on page 5.
  

• Don't Go to a Hospital in July, or is That July Business an Urban Legend? You decide after reading page 3 (also, try not to get admitted on a Friday after noon).
  

• Flattery Always Works: Want an appointment with a top-notch specialist? Tell them you're a fan and are glad to be there.

• Don't Refer Difficult Patients: Docs (at least some in this article) don't want your hypochondriac sister-in-law, your multi-chronicity Grammy. They may, however, want your well-paid working professional book-club friend who arrives and pays on time. To be fair, I'm carrying this a bit far - Dr. Heart1 did mention referring good patients is appreciated.

• Drug Companies & "Low Level Bribery": Dr. Virus has a great example of a steak dinner thrown by makers of an expensive antibiotic. Dr. Heart2 describes being 'wooed' and why we might take a closer look at Big Pharma's relationships with hospital purchasing depts.
  

• It's All in the Degree: How to pick a doc? Check out where they went to med school (cardiologist).
  

• Yellow Pages Anyone?: Picking a doc was compared to having a personal shopper, choosing a car mechanic, accountant, and lawyer.
  

• Why Brand/Image Matters: Pick a doc by selecting a hospital 'brand' you like ("I think better doctors are typically at better hospitals"). Side note: I had an experience with one of the best ortho surgeons I've ever met at a tiny community hospital in the mountains of Cumberland, MD. His care and results equaled that of some more 'branded' physicians at a top trauma center in Baltimore, MD. Can't docs, like professionals of any other ilk, have stellar reps and pick an area based on familial ties, schools, quality of life, etc.?

• Seek Those Who Teach: If you go to a teaching hospital "your statistical risk of turning up a clown is much lower" (infectious diseases doc). I'd like to see the aforementioned stats on this, but that would sort of defeat the whole masks-on-the-back-of-the-head, secret-agent anonymous-commentary angle.
  

• Why You Want the Number 2 Heart Doc: Dr. Heart1 said don't pick the tip-top heart doc at a university hospital - this MD has published papers, talks the talk, but may not be able to walk the walk.
  

• Use Referrals: "There can be good doctors in small hospitals and bad doctors in big hospitals. That’s why you also want a patient recommendation." - Dr. Lung
  

• You Can't Escape It -Network, Network, Network: Getting in to see a specialist is all about the referral. Oh, and what type of insurance you have and how quickly they pay.

• The 7 Minute Rule: "If you’re an HMO doctor, the network will tell you to see, on average, a patient every seven minutes."
  

• Bring Jokes & Food: Shocker - like just about any other professional under the sun, docs spend more time with people they like. "You have fun with patients you like." - Dr. Baby
  

Favorite (?) SiCKO worthy quote (along with each doc sharing medical mistakes):

"HMOs tell us to see more patients; malpractice insurance tells us to take all the time we need."-Dr. Baby

Good Grief, There's More:

"Research is a real problem. Doctors just make up the data." - Dr. Lung

Favorite funny quote:

"You deal with professionals who know more than you in all walks of life, and you somehow learn how to find out who’s full of shit and who’s not." -

Well, that makes a great soundbite. But how much experience with the 'system,' i.e. what level of chronicity/acuity does a patient need to have before they can pick the good docs?

The doc who compared it to picking a lawyer or accountant did have an interesting metaphor - all things being equal (meaning I could hop online and find a complete, relatively accurate listing of docs in my area with 'ratings' from 'users' a la travel site Tripadvisor.com), I'd pick a doc based on their publications, reputation in the community, standing/awards, and referrals from trusted sources, including a PCP.

NOTE: RateMDs.com, a relatively new site, is one to watch. Also check out the graphically-clumsy HealthcareReviews.com. Revolution Health's Care Providers page shows some promise to further develop a rating capability, but there's room for an aesthetically pleasing, easy to use site to enter the market.

Oh, and I'd also consider price and whether or not the office accepts cash, my insurance, etc. Do they have convenient parking? A pharmacy in onsite/in the same building? A coffee machine in the waiting room? Just kidding (kind of).

How many of us really 'pick' our doctors in the same way that we pick car mechanics or realtors?

Is it realistic to believe many of us are finding a doc, who has approx. 5-40 minutes of room-time per patient during a PAYING appointment, based on his/her background, degree, areas of research interest, etc.?

Hopefully, you learn how to find out whether or not a doc is full of shit before you really need her to step in and dirty those gloves saving your life or limb.