Patient Experience Matters: A Reflection on my Personal Woes and Observations
As I arrive at the address programmed into Google Maps I realize that all street parking is taken and I have a choice: to pay the absurd amount to park in the designated parking structure or park blocks away in a residential area and walk. I circle around and opt for the walking option, as it is best for my health and my wallet. When I arrive at my new doctor's office (health insurance changed, and thus, primary care physician) there are several panes of frosted glass, each a window designated for the individual physicians practicing in that clinic. I'm immediately struck by the feeling of a cold, isolated, unbecoming welcome. It felt as if I was arriving for processing prior to being deloused prior to entering into federal prison.
An early adopter of the ZocDoc platform many years ago, I've sworn to only find and book doctors through this platform as it affords many benefits to patients-- but primary in scheduling, record keeping, and time-saving by filling out a set of standardized medical history forms which can be cross-referenced by your new healthcare providers. Despite my gleeful expectation that because I booked through ZocDoc, I wouldn't have to endure the 20 minute intake form I was dismayed to find out that indeed they had ignored this feature and I was expected to arduously complete "their" set of paperwork.
As I paid my co-pay and was called to enter the exam room I sat patiently waiting for my encounter to begin. As the doctor entered, he entered to poignantly notice that the room was devoid of a computer for charting. Embarrassed, he invited me into his personal office down the hall. As I began to detail my history (painful in and of itself, as I've seen so many doctors over the years due to insurance changes/job changes/moving etc.) knock after knock came to his door. Some would even enter without a knock, peeking their head in to ask questions, not realizing he was seeing a patient. Poker face intact, I would restart the dialogue after every interruption.
Without preface, I was summoned directly to the phlebotomy station for a blood draw. No discussion of what we might be testing for or the value it could bring to bringing color to the picture of my health and pursuit of wellness. I was surprised to see that the gauge of the needle was overly large and painful, all for one simple tube of blood. I returned to the exam room (the one without the charting capabilities) to have a brief discussion with the doctor that left me in surmising that he had not well assessed my health literacy. He spoke to me in generalities, and I would respond clarifications like, "oh, so we're doing a comprehensive chemistry panel to look for creatinine" to let him know, unabashedly, that he could speak to me like a competent healthcare citizen.
As he began to dismiss me to leave I jabbered on about how this was my "annual physical" but I had hoped to kill to birds with one stone to discuss an active health problem I was currently facing. Surprised, he came clean that he did not know that was the intent of this appointment and then gave me the option to have the exam and ensure a second stick to obtain the blood tests that are standard of care at such an appointment. I waited in the reception area. Ten minutes. Twenty minutes. Thirty minutes passed. I finally stepped up to the front desk to inquire when I'd be seen for my second phlebotomy sesh. Buzzing around to those casually talking in the hallway about this weekend's plans, I was finally notified that I had not been forgotten and I could now come back to the phlebotomy suite.
As I sat in the padded chair the phlebotomist dashed in and began haphazardly throwing items around the station. Several items landed on the floor in a whirlwind of gauze and tourniquets. As I tried to reach below my seat to retrieve said items he responded, "oh, don't worry about those the cleaning crew will get them". Blood draw round two involved the phlebotomist shouting to staff in nearby rooms, looking for direction has he had so promptly left them behind mid sample collection. "Just the sputum, just the sputum!" he recounted, seeming to get louder and louder with each repetition. At this point, I was well past the one hour allowed for street parking and anxious to return to my unattended car. I smiled and exchanged pleasantries as I made my exit.
It is experiences like these that both shake and invigorate my faith in healthcare delivery. Competent clinicians can, knowingly and unknowingly, miss the mark entirely. I have grace for these individuals, but I also believe that patients deserve better. Patients deserve to enter a smarter, well-informed, coordinated environment where concierge-level, value-based care is not an upgrade, but rather the standard of care. The patient journey should be well pre-meditated, orchestrated, and executed with excellence. We are dealing with human beings, and deserve to be treated superior to the cattle we eat. I know I am not alone in this frustration, and have recently commiserated with other friends and family on their experiences. All too often I hear, "They told me they would call with my results, and no one called" or "The radiologist asked ME what vertebrae they would be scanning".
In a recent ultrasound appointment I inquired what, financially, I would be responsible for after a claim was placed with my insurance. No one could tell me. I asked if a "pre-cert" had been done and was reassured that it had and it was standard intake procedures. A few questions later, I was then notified, "we don't do pre-certs for ultrasounds". I was finally given a phone number to call. I sat, waiting on hold, while the window for my appointment escaped beneath my feet.
This is not okay. We can do better. This is why I believe that improving the culture of healthcare starts with each and every one of us. There's an adage that alludes to the fact that you teach others how to treat you. I wholeheartedly believe this, and it has many parallels in the healthcare paradigm. Each time your patient experience is unsatisfactory, let the right people know with constructive criticism. What this industry needs is beyond the obvious scope of overworked clinicians; more patient navigators, designers, data scientists, and engineers. We need patients to be treated as the experts that they are in their own health. We need scientists and care providers to have the creative confidence to do things differently.
Quality improvement will come when participatory design is integrated into the many layers of interaction we have in the healthcare marketplace. I'm hopeful we're headed in the right direction with precision healthcare, highly personalized digital biomarkers, ActiveTasks, and greater access to actionable health insights and predictive data. We can achieve better healthcare by design. We can design for preventative, wellness-focused health and healing. Healthcare is no longer delivered within the four walls of a doctors office. We need leaders designing for the real-world context of across the continuum of point of care, family context, community context, etc. and we need patients to take ownership of their health, projecting their patient voice and choice.