“Al,” I said, “we want you to take less time to complete this project and, because of your reputation as a top-notch carpenter, we feel sure that you will be able to do the high-quality work you have always done. But because we are asking you to take less time, we won't be paying you as much as you usually receive.”
My husband and I just finished renovating our house, and I've just imagined this conversation with Al. For 6 months or so, our house was filled with three carpenters, innumerable plumbers, one electrician, and a host of other construction professionals. Early on, we became close to these craftsmen and they to us, building relationships that I know will last. For all of us, the entire renovation process had its foundation— both literally and figuratively—in these relationships, these special, people-to-people connections.
All these craftsmen took pride in their work and wanted to give us the best that they could. Of course, we would never have dreamt of asking any of them to work more quickly while also asking them to lower their usual high standards and to be paid less money than they usually charged. It would be an absurd and, frankly, disrespectful request. The conversation in the first paragraph would never have occurred because if it had, we would not have had carpenters, plumbers, an electrician, and all the rest working for us. Who the heck would want to do the job?
Yet this same request is made of PAs and other health care providers in our current health care system—see a patient every 10 or 15 minutes, provide high-quality care at each encounter, and receive less reimbursement for the services rendered. How is it possible to develop any type of high-quality relationship under these conditions? It seems that time has become a commodity in our system: patients purchase time in 10- to 15-minute blocks, and health care providers try to spend that time as efficiently and compassionately as possible. In such a system, are any of us getting our money's worth?
The Consumer Reports National Research Center recently surveyed more than 39,000 patients about their doctor visits.1 More than 25,184 respondents to the 2006 Annual Questionnaire were asked about visiting their doctor for treatment of their most bothersome illness. Then, during the summer of 2006, 13,906 online subscribers were polled about preventive care visits. A total of 335 primary-care physicians were also surveyed about “how things look[ed] from the other side of the table.” Although Consumer Reports acknowledged that the subscribers they surveyed might not be representative of the population as a whole, some of their findings are thought-provoking.
The good news is that the majority of patients said they were highly satisfied with their physicians and they got better under their doctor's care. Of the percentage of readers who rated their doctors as “excellent,” 77% said “he treated me with respect.” Another 67% bestowed an “excellent” rating because the doctor listened to them with patience and understanding; 64% did so because the physician seemed to care about their emotional well-being.
The major complaints of patients about their doctors related to time: they were kept waiting for 30 minutes or longer (24%); they could not schedule an appointment within a week (19%); the doctor spent too little time with them (9%); they didn't get test results promptly (7%); and the doctor didn't respond to phone calls promptly (6%). In contrast, what bothered doctors about patients ran the gamut: patients didn't follow their prescribed treatment (59%), waited too long to make an appointment (41%), were reluctant to discuss their symptoms (32%), and requested unnecessary tests (31%) and prescriptions (28%). According to this survey, patients are most bothered by a system in which there appears to be not enough time to meet their needs—for an appointment, for test results, for a return phone call. Yet within the time constraints, an important relationship develops for these health care consumers.
Using the feedback from survey respondents, Consumer Reports created a four-part checklist of questions for patients to ask during a 10-minute office visit to make the most of the allotted time. The checklist includes questions about “Your Ailment” (What is my exact diagnosis? How long will I be sick?); “Tests” (Why is this test necessary? Will the results significantly alter any treatment plans?); “Treatments” (What treatments are used for my condition? Which is best for me and why?); and “Lifestyle Changes” (How will this help my disorder? How drastic do changes need to be?).
That's a lot—and probably impossible—to do in 10 to 15 minutes. However, I liked the checklist's simplicity and how it can empower patients to ask important and straight-forward questions. The checklist also seems like a reasonable approach to engage patients in a dialogue about their care. Try it and see if it provides the beginning—the foundation—of building relationships, one patient at a time. JAAPA
Sarah Zarbock, PA-C, is the editor in chief of JAAPA.
REFERENCE 1. Get better care from your doctor. Consumer Reports. 2007;72(2):32-36.