"...the complaints I hear from patients, family and friends are never about the dearth of technology but about its excesses."
Read the very nice op-ed in: www.nytimes.com
We hear this from almost everyone who has been on the patient or caregiver side of health care: "The tech is great, keep up with the cool new gizmos, therapies and drugs, but could we please get back to some of that caring and human compassion or was that just in the movies?"
The importance of the patient's experience of care is not simply a marker of 'patient satisfaction' - it is indicative of the quality of care.
More from the NYT op-ed:
This computer record creates what I call an “iPatient” — and this iPatient threatens to become the real focus of our attention, while the real patient in the bed often feels neglected, a mere placeholder for the virtual record.
I find that patients from almost any culture have deep expectations of a ritual when a doctor sees them, and they are quick to perceive when he or she gives those procedures short shrift by, say, placing the stethoscope on top of the gown instead of the skin, doing a cursory prod of the belly and wrapping up in 30 seconds. Rituals are about transformation, the crossing of a threshold, and in the case of the bedside exam, the transformation is the cementing of the doctor-patient relationship, a way of saying: “I will see you though this illness. I will be with you through thick and thin.” It is paramount that doctors not forget the importance of this ritual.
And a couple of recent quotes from primary care clinicians in the front lines:
I used to work in a clinic doing family Med. I had a meeting with the owner one day: I was told that I was a good clinician but I needed to order more carotid US, PFT, dexa scans. I learned that the owner had a guy with a mobil US to do US q weekly, they also had equipment to do PFT and a dexa scan. I responded to the owner that I order a test when is indicated not because I want to trick or get money. I was not liked and few months later I got a dear John letter notice to look for another job.
and:
I am allotted 10 minutes for follow-ups even if I have never met the patient. Same for acute visits. There is no time to breathe during the 20 minutes scheduled for a new patient.
This is a recipe for disaster: caring clinicians working in a broken system. We have a toxic brew of miss-aligned payment policies that reward the health care delivery system for the failures of primary care. The results is primary care burnout coupled with the incredibly high cost to our society of delayed diagnosis, missed opportunities for early intervention and pounds-upon-pounds of 'cure' due to the lack of an ounce of prevention.
No one intended to create the environment that is so toxic to caring and compassion, that is so costly to both our wallets and our humanity, but the solution will not happen without thoughtful action.
Health care spending must shift upstream to fund the work of prevention and early intervention, the low-cost/high-quality efforts that are the hallmark of effective primary care.
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