The patient is not the customer
I’ve been lurking in the halls of medicine lately. This time not for pay, and not for kicks. I’ve been a patient.
I’ve got a fairly mechanical glitch, am not feeling unwell, so I have lots of energy to think about the patient experience, noting the signs and handouts, the many message deliveries in all their media and formats. When we are patients, or serving as patient advocates, dozens and dozens of messages and media give plenty of ways to study communications (and their breakdowns) in the hospital environment.
I also know, having relatives in the medical biz, and having facilitated interviewed a fair many health care professionals, that the challenges of keeping up to date on health care information are great and getting greater every day. I have great sympathy for the people who care for us, certainly. Communicating among themselves is hard and communicating clearly with patients is harder.
In this one “use case,” in a 24-hour stay at my local hospital and a week of follow up care, and another week at a research hospital, I have received four slightly different versions of my prognosis and differing care plans from six physicians. I tripped over cracks in the floor formed by varied motives of entities I didn’t know were competing (this lab vs. that lab, hospital vs. doctor’s office, for-profit vs not-for). Overall, I was able to unravel it, and none of the communication glitches put me in any grave danger. Unnecessary discomfort, bruising, hours wasted, yes, but no real danger.
Add to that the usual hassles, the records not quite able yet to transfer digitally from office to office, hospital to hospital, the missed queues, wrongly routed prescriptions, fuzzy or out-of-date and incorrect instructions. And always that cruel law presiding over the pursuit of health care — that the most frustrating events will happen when you are at the end of your physical or emotional rope.
Relatively speaking (in relation to past experiences, I mean), it wasn’t a bad patient experience. But these wee frustrations did remind me of the experience of looking after my mother during her unsuccessful fight with cancer, and trying to carry messages from hospital to hospital, surgeon to radiologist, radiologist to chemotherapist, practice to practice. We learned it takes three trips or three tries before a message can be delivered or received without distortion. As long as my mom and I expected that, we were able to be a little less afraid.
In health care, though a sincere desire to help people is the calling for most people who work in the field (many of whom break rules daily to fulfill that calling), the experience that has been created is not customer-focused. The experience suggests that the patient is not the customer. Insurance companies and employers, health care laws and protocol compliance, administrative goals, regulations, standards, and the current day’s workload appear to be the customers.
Patients feel like raw material for medical assembly, dropped off at the front of the plant, and rolled out the back, transformed by the medical process into the medical product. We often complain, because we have no idea what is happening to us, no idea who will tell us what we need to know, or when. Confusing messages confuse us. And we are afraid. One of the last things my nurse handed me as I was wheeled out of the back of the hospital was a post card. “How are we doing?” read the headline of the tiny little survey. I was asked to check one of three boxes to report whether my stay Exceeded? Met? Did not meet Expectations? That one data point will be recorded by an administrator who includes patient satisfaction among the scores used to measure the performance of… Whom? What? The facility? The doctors? Nursing staff? Housekeeping? Food services? What reliable data can these wee cards offer, I wonder…
There is a groundswell of caregivers who want to provide better patient experiences. I cannot imagine how the patient experience can be improved when the patient is, and is necessarily, so far from being the customer. When caregivers themselves are not rewarded for improving the experience of patient care. Outcome, yes. Experience, no.
And so there is a great deal of competitive window-dressing among medical product plants. New drapes and imitation wood floors won’t help a patient who is afraid for his life.
The patient-as-customer problem won’t be fixed soon. But I did learn something about my stay at a research hospital. There the patient is still not the customer, but is certainly considered to be a full partner in the work. We may not be able to create a good customer experience, but it doesn’t seem beyond our current reach to create a better partnership between caregivers and their patients.
And good partnerships begin with communication. We need clear and consistent communication about our condition and treatment, respect for and the means to do our own research so we can bring intelligent questions to the care consult, and the simple confidence that the diagnoses, prognoses, and treatment plans are clearly communicated among all of the partner caregivers we will encounter in the course of our treatment. I’m a hopeless technoptimist, and believe we can digitally (I know that word means something else in the medical field) close the gap on this patient partnership problem.
Our health care providers do not need new marble floors nearly so much as they need a good patient communications system, one system that everyone refers to and uses, that gives the patient instant access to their information, a means to read up on the latest literature, or to find a researcher who can help them understand their options, and follows the patient from caregiver to caregiver and home again. How close are we, anyway? I wish I knew. We must be close. I have faith that we’re really very close.