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Health Sentinel: Diagnosing the patient-doctor disconnect

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Gripes about doctors

Scores are based on a 10-point scale, with 10 being the most bothersome. Differences of .4 or less are not significant.
•Unclear explanation of the problem, 8.1
•Test results not communicated quickly, 7.9
•Billing disputes hard to resolve, 7.8
•Hard to get quick appointment when sick, 7.8
•Rushed during office visit, 7.8
•Discharged too early from hospital, 7.7
•Issues discussed within earshot of other patients, 7.6
•Side effects not fully explained, 7.6
•Long wait for doctor in exam or waiting room, 7.6
•Hard to reach doctor by phone or email, 7.0
•Doctor too quick to recommend tests, 6.7
•Inconvenient office hours, 6.5
•Doctor won't renew prescriptions without visit, 6.2
•Doctor takes notes on device, not looking at patient, 6.2
•Must fill out many forms in waiting room, 6.1
•Doctor discourages alternative treatments, 5.7
Source: The Consumer Reports National Research Center

What doctors say about patients

In a poll of U.S. doctors, the following were listed as some of the greatest challenges doctors had in providing patient care. The findings were published in the May 2011 Consumer Reports:

*The top gripe was patient noncompliance with advice or treatment recommendations; 37 percent said it affected their ability to provide optimal care “a lot.”

*When it came to their patients getting better medical care, 76 percent of doctors said patients forming a long-term relationship with a primary-care physician would help “very much.”

*Seventy percent said since they started practicing medicine, respect and appreciation from patients had gotten “a little” or “a lot” worse.

*Forty-two percent of physicians said health plan rules and regulations interfered “a lot” with the care they provided.

*Only 37 percent said, when it comes to minimizing patients' pain and discomfort, they were “very effective”; 97 percent said they thought they were “somewhat effective.”

Monday, June 3, 2013 - 12:01 am

This month's Consumer Reports magazine features results of its affiliated research center's Gripe-o-Meter study in which 1,000 U.S. individuals were asked to rate their doctors on 16 issues. Gripes were rated on a 1 to 10 scale, with 10 being the biggest complaint.

I surmised at or near the top would be lengthy time spent in waiting and exam rooms before seeing the doctor. Instead, the No. 1 gripe was “an unclear explanation of the problem.” A long wait for the doctor in the waiting or exam room was midway down the list.

Why are patients not getting clear explanations of their diagnoses or conditions? Is it patient perception or reality? What is hindering doctor-patient communication?

Patients often feel inferior to their doctors, sending themselves self-deprecating messages that their opinions, ideas and worth in society is less than their doctor's because the doctor has decades more education and a bigger bank account.

Patients need to put things in perspective: that doctor goes to the barber or beauty shop, needs a car mechanic at times and likely takes the garbage out now and then, grateful that someone – maybe you – are willing to drive the truck that hauls the garbage away.

Lack of time during the doctor visit has been cited as key to doctor-patient communication breakdown. The Center for Disease Control's 2010 National Ambulatory Medical Care Survey found one-third of doctor visits lasted 11 to 15 minutes and a little over one third lasted 16 to 30 minutes. That was based on 2009 data.

In the year 2013, I think it's a rarity to have 20 to 30 minutes with a doctor. But that's not necessarily the doctor's fault.

A few years ago, a family practice physician told me he was pressured by the entity that owned the group practice to see more patients per hour. He was told he wasn't meeting the revenue “formula” set by the owning entity. He switched to a group practice owned by another entity which promised things would be different.

In less than two years, that greener-grass practice had the same demands: see more patients. This smart, empathic young doctor left Fort Wayne — a loss to the community. The push for doctors to see more and more patients sends my Gripe-o-Meter to Level 10.

Here are some thoughts of two individuals I queried on the doctor-complaint issue; both have extensive experience with multiple doctors.

Marlene Lines, 79, had the same family doctor for 40 years but says, “After he retired, I never did find another doctor I liked as well.” Lines' medical needs grew as she got older. The New Haven resident found herself dreading going to specialists, who did not know her or her family and who always seemed rushed for time. The latter is the 5th most common complaint on CR's Gripe-o-Meter.

“I felt like I had to get everything out in the first breath or the doctor would be out the door before I could explain things,” Lines says. She also was frustrated over the length of time it took to get an appointment. “If I was sick, there's no way I could get in to see the doctor that day.”

So Lines looked for an alternative, finding an agency that sends a nurse practitioner (NP) to her home. The NP, who works with a physician, makes monthly visits but comes more often if Lines' medical needs merit it.

“Sometimes she's here 15 minutes, sometimes an hour. She listens to what I'm saying. She doesn't act like I'm too old or that I don't know what I'm talking about.”

In between visits, Lines emails the NP if she has questions or concerns, adding, “I'm so much more pleased with the care I'm getting.”

Heather Sosenheimer agrees doctor-patient communication is crucial and challenging. But equally so is the doctor-to-doctor communication.

A Fort Wayne mother of three boys with complex medical issues, Sosenheimer says, “Over the years, we had to be the line of communication between (the doctors). It's difficult getting them to communicate with each other,” even with the prevalence of electronic health records (EHR).

Hospitals' have their own EHR systems that may not be accessed by another hospital or doctor's office. That missing link of doctor-to-doctor communication has caused her sons to have redundant, costly tests.

“I wish doctors would communicate with each other and figure out a treatment plan among themselves,” says Sosenheimer. She's learned to ask for copies of all test results, keeping them and notes from every visit in separate binders for each boy. “I take them to each doctor appointment.”

Also on Sosenheimer's medical Gripe-o-Meter: Doctors stating a diagnosis, particularly if unexpected or rare, then walking out of the room when the patient or family asks few or no questions.

“I wish they would walk in and tell you something, then give you time to mull things over,” she said. “There needs to be a delay. I remember being given a diagnosis and sitting there, trying to think of questions.”

Twenty or 30 minutes later, back in the car, the questions surfaced. If the doctor allows the patient or parent to email their questions, it's not such an issue. But too few physicians are on board with that.

Such situations clearly shed light on patients' No. 1 complaint: “unclear explanation of the problem.”