My wife came home from work the other day with a story that brought back memories for me. She’s a family dentist in Cocoa Beach, FL, a beachside community that sits at the epicenter of a 500,000-person county yet somehow still manages to feel like a small town. A new patient, an elderly lady, came in to see her for the first time and immediately recognized her name. By coincidence, I had treated her husband four years earlier when he was hospitalized with a major infection. Though her husband has since unfortunately passed away, she still remembered me as his doctor and was excited to meet my wife. When my wife told me the patient’s name, it also triggered in my mind the memory of treating that patient and his family. Having just spent a day in meetings focused on health outcomes, data analytics, and quality-based reimbursement, my wife’s story and the associated memories reminded me of what’s really important in health care.
I believe that the healthcare industry must be transformed. I go to work every day to make that happen. Yet, I also believe that, even as we transition to a more efficient, market-sensitive and customer-focused system, we must not lose sight of the kind of impact doctors can have on the lives of their patients.
A Spectrum of Approaches
What most service industries call customer service, for instance, we in medicine call bedside manner. The difference between those two ideas is difficult to define or quantify. It’s more art than science. But medicine has always been a discipline that works along a spectrum of hard and soft approaches. At one end of that spectrum, we base treatments on evidence, protocols and lab results (and, increasingly, costs), but at the other end we rely on empathy, intuition, and a patient’s values and feelings to make the best care decisions. The simple term “healthcare,” used daily throughout the industry, somehow encompasses that range. When we talk about improving healthcare, it’s easy to focus on the impressive advances that have been made in the science of health, but I believe the art of care probably still has a bigger impact on patients’ lives.
The best doctors I know are brilliant clinicians but they are even better human beings. I could name dozens who go above and beyond the protocols and guidelines required of them for reimbursement. For such doctors, the metrics of reimbursement represent the bare minimum of healthcare. For other doctors, perhaps reared in today’s more economically constrained era, such metrics seem to cap the maximum threshold required of them to provide care. While I have no doubt that those doctors practice scientifically advanced medicine, I fear that the care – the customer service or bedside manner – they provide may have diminished. I am dismayed by that, and by the number of great doctors I know who are leaving medical practice without being replaced with people who share their ideals.
Listening to the Patient
When patients complain about health care, it’s important to listen. Many of the stories I hear are less about health and more about care. Patients are frustrated that they frequently wait too long for a visit that is too hurried. They often feel as though they walk away from a healthcare encounter with more questions than answers. They struggle to see the same doctor twice. They encounter cold, uncaring physicians who rush in and out of the exam room without demonstrating much sympathy, attention or engagement. These experiences are so common as to seem almost stereotypically normal.
From the practitioner side, I understand the pressures that lead to these kinds of encounters. But I cannot help but lament the damage that is done. Patients who don’t trust their health care providers don’t share details, don’t ask for help and don’t listen to advice. A strong doctor-patient relationship, with its bond of trust, has always been at the core of what brings value to health care. My wife’s patient reminded me that people appreciate improvements to their health, but forever remember the care they receive. As we push forward with the challenge of health care reform, the impact of care must remain front and center. Without an appreciation for the art of care, our nation’s collective health will never achieve the level of quality we are seeking.