Sunday, July 7, 2013

Is your Doctor good at their Job?

It started with a simple tweet, as some of my better posts topics do:

If you read through the whole thread, you'll understand the title of this post.

Here's the point.  Until patients judge healthcare providers by the non-medical things they do, most providers will just continue to give us the same kinds of service they always have.  Paper forms, crazy bills that we can't understand, lousy communications, et cetera.

We put up with those things because the providers are "good at their job."  But are they really?  Isn't customer service part of their job?  We all complain in one breath about how the system needs to change, but how many of us have ever changed doctors because we couldn't get our data easily?  There are providers that have the capability and use it, and there are many others that don't, and there are some, like my own, who are working on it, but still aren't there yet.

How do we make physicians understand that making our data available to us is a critical part of their job?  The easy answer is to pick physicians and hospitals that do.  But that is not so easy now is it.  Do you really want to give up the doctor that you have a 20-year relationship with?  I know I don't.  Do you even have those choices?  I do to some degree because of where I live, but not everyone else does.

One of the intentions behind Blue Button+ is to change that.  But making technology available is only the first step.  And while @CLOUDHealth and I might argue about the shape that technology takes, I don't think he'll argue that it takes more than the availability of appropriate technology to change society.  It has to be used.

In the The Forever Hero Series, L.E. Modessitt's main character Gerswin discovers that it isn't just the development of appropriate technology that is necessary, it has to be used by, and demanded by the common man before change can occur.  The BestMeat plant that his institute funds the development of fails to change society until Gerswin starts sharing the fruits of that plant with others.  This is where S&I Framework stands today.  We have developed some of the appropriate technology, but we need to get the word out, and create the demand for it.

That is one of the key messages from the Patient Access Summit II.  As I summarized it: More needs to be done to raise awareness among patients, providers and health IT vendors about patient rights and technology available to access data, and Blue Button Plus alignment with Meaningful Use incentive programs.

But of course, if we expect ONC to make that change happen, we'll still be waiting for it.  The government is not well known for their marketing prowess.  I'm a patient and a technologist, not a marketer. I don't know how to do this, or what it would cost to get the word out.  But I know that's the next step.  I think we need to spin up a simple yet viral marketing campaign to make patients aware that a) they have a right to their data, and b) they should ask for it.

I can teach that to an eight-year-old, why is it so hard with adults?


  1. I think that it's ridiculous for @CLOUDHealth to ask "If he is so good, why are his interactions with his patients so 20th century?". A doctor's goodness should be measured by the quality of the medicine that they practice, not how well they've managed to become experts at applying the latest technology, or running a business.

    1. I think I said that. My point is that if we judge doctors by how well they practice medicine alone, then we shouldn't be surprised when they don't do anything other than that.

    2. >> "..then we shouldn't be surprised when they don't do anything other than that."

      And that's not a bad thing for those who've got their priorities set correctly -- I would go to a medicine man in the remotest part of the world with no computer and no Internet if they held a cure for my child, rather than go to a provider with the latest and greatest EMR who's just guessing.

    3. Thomas, while I would do the same, I cannot help but notice the incongruity of saying the provider is good at their job but complaining that there are other things they are not doing well. If it's not part of their job, why would you expect it?

    4. Keith, the availability of an interoperable EMR, to the degree that it enables a provider to know closer to everything about the patient that's in front of them, can certainly make a good doctor an even better one.

      The only point I was trying to make is that a good doctor is still a good doctor even without that enabler.

      And I didn't necessarily think that we disagreed on anything. I was responding to the Tweet that @CLOUDHealth made in the thread that you referenced in you post more than anything that you'd said.


  2. One thing that I see for my neurologist (in particular) is that while he is an excellent doctor, he is (to the best of my knowledge) an employee of the medical practice at which he works (which is in turn an affiliate of a local hospital system). His job is the medicine; the practice has other employees whose job is "the non-medical things they do". I can, and I think should, demand that the *practice* do the non-medical things well; but I'm not going to demand that the *doctor* should - at least if I don't know that he has some control over hiring the non-medical employees.

    Just a refinement of what you said.

    1. I definitely agree that the non-medical things are in the domain of the practice. However, I will say that there are some truly terrible EHR systems out there that are more confusing than paper due to stupid features on the 'header' section for the patient. I think most doctors just try to 'deal' with the EHR system, so it would be nice if there were a way patients could discuss the dangers of bad systems with their doctors. Unfortunately, it requires patients to view their doctors as partners in their healthcare and not gods. Too many doctors feel they are entitled to god status, and too many patients are afraid or were brought up not to challenge that status.

      Also, how many patients even know they are entitled to have a copy of their records? I had a hard time getting mine about 10 years ago and was unsure what I could do about it. A lawyer friend of mine told me that it was my right to have them. The only reason the practice complied finally was because I called them and said, "My lawyer says I am entitled to a copy of my records." Problem solved, but how many patients have the ability or knowledge to do that?