Shopping for pediatric care? consumer tips from a "provider"

The last two weeks, I have taken the bait and jumped into the fray of discussing "consumerism" in healthcare. Two weeks ago, I outlined my perspective on the chaos of consumerism . Last week, I emphasized the need for consumers to understand where and what they were "being sold ." Healthcare is currently in an amazing time where the focus is not on quality, continuity, or value, but rather on convenience and consumption. Consumers are now being told that care is really all about the "selling" of rapid, on-demand, convenient access to care.

However, as highlighted above in the image, this approach is actually costing you more!

If we are to adopt the consumer approach, then we should focus on how to save "out-of-pocket" costs. The graph above illustrates the consumers' growing expenditure on outpatient care.

As a pediatrician, pediatric emergency physician, and father, I thought it would be helpful to offer my perspective on what I observe from those who are seeking pediatric care. The first step is challenging your current thinking and being curious about whether you are being told the truth by the "sellers" of more care.

I would argue that the biggest factors driving your outpatient costs are believing the following myths about care:

1. Convenience is king. Just like fast food, rarely is the best food offered in the drive-through line. The same is true for healthcare. If you are waiting in line for coffee or a chicken sandwich, please ask yourself why you don't do the same for your child's healthcare?
2. All "providers" are the same. Nope, training and experience are incredibly important in medicine. My 30 years of experience have humbled me to the nuances of pediatric patients and their families. Algorithms and bots can't and will never replace clinical experience. If you seek less trained and less experienced providers, then expect to spend more on testing, receive more prescriptions, and likely require more follow-up visits. Additionally, anticipate critical "misses" in diagnosis or "overdiagnosis" that may impact the need for more care or even more critical care. Remember, both overtesting and undertesting are critical problems resulting in more care and more problems. They will also cost you more "out-of-pocket." Your best best is not a provider but rather an experienced clinician who knows when and when not to "provider" care.
3. Continuity doesn't matter. Wrong again. The power of an established and continual relationship is essential in healthcare. Sure, as a pediatric ER doctor, I can take care of your sore throat or broken arm as well as or better than anyone else. However, during that visit, I can't check on your mental health, weight, family stressors, social determinants, or offer you comprehensive care. Sick care and well care are best provided by those who know you or should know you better. Another advantage is that if you contact your primary care provider first, they can guide you on where, when, and who to see based on their experience. Consumers randomly choosing care is a significant problem that, again, will drive up your costs and increase the risk of not receiving the best care.
4. Dr. Google knows best. The most common way parents seek medical advice is by consulting Dr. Google. What a great way to get bad information, poor guidance, and fall into the trap of social media influencing your decision-making. You are not buying a grill or seeking the next fashion trend; you are seeking insight into your child's health! The best way to receive guidance on your child's condition is to call your pediatrician. It amazes me how many parents search the web or go to the nearest "provider" when their child is ill or injured. If your car has a problem, do you just drive to the closest mechanic? I find it mind-boggling that parents do this for their child.

From my experience and perspective, I believe "consumers" need to know more about the impact of these "random choices" and the ripples of these choices on you and your child. Overall, you can expect more care, more visits, more labs, more prescriptions, more out-of-pocket costs, and lesser outcomes.

As the data has repeatedly shown, what you really need and should invest time and resources in is establishing a connection with primary care . A continual primary care relationship is beneficial in terms of all the aforementioned aspects, including your out-of-pocket costs. If you don't believe me, feel free to ask Dr. Google. Here is an example of what you will find : "Greater use of primary care is associated with lower costs, higher patient satisfaction, fewer hospitalizations and emergency department visits, and lower mortality."

So, here are some key tips on how to save your healthcare dollar and get your child the best care. The key is to find the right provider, one who embraces the basic concepts of the "medical home ." We will discuss this further next week.

As a consumer, finding this type of provider is becoming increasingly difficult. I understand that. However, before you call me idealistic or accuse me of being unaware of the current primary care challenges, let's first explore how streamlining continual care may actually better meet the needs of patients, consumers, and clinicians. Chaos , remember, is causing many of our problems.

Overall, if we are going to promote consumerism in healthcare, then it's time for consumers to push for better and not just accept more random and higher-cost care. In the coming weeks, I will highlight how to shop for the best providers and even provide you with a shopping list to explore.

It's time for "providers" of care to be pushed to meet the needs of patients and help us lower our costs and provide the best care for our children. As a provider, I truly believe we can achieve this, but it will require new thinking and better execution.

Note:?As a reminder this newsletter is written from my experience and perspective.?The newsletter does not imply or relay the opinions of others.??The intent is to offer an avenue for dialogue and discussion around important topics in healthcare and healthcare innovation from one doctor’s perspective.??I am a physician and so can only write from my perspective.?If you are clinician, provider, nurse or whatever my goal is to enable you to agree or disagree.?I have no intention to suggest or imply that only the physician perspectives matter.??They do matter but as part of a larger dialogue that can foster better health outcomes.