by Evan Falchuk
President of Best Doctors, Inc.
Dorothy woke up in the Land of Oz.
She had been through a lot, and now her life had changed, maybe forever. Worse, she had no idea what to do, let alone what was really wrong.
Lots of people gave her advice, which she followed. But the advice only got her so far. Before she knew it, Dorothy hit a crossroads and had to make all kinds of new choices. Where do I go? Who do I trust? How do I know I’m making the right decisions?
Dorothy’s experience is a good metaphor for what it’s like to be sick. Every day patients travel down a treatment path with no real direction. They face forks in the road of their care without the guidance to confidently choose the right path. Many say that we can solve these kinds of problems through consumerism. Sure, patients are “consumers,” but their problems are
deeper than what smart shopping can cure. Why is that?
It has to do with the one thing in shortest supply in our health care system: time.
Data from the U.S. government show that in a typical doctor visit has face-to-face time with the doctor of
15 minutes or less. This means that doctors have less time than ever to get to know their patients and think about their problems. It also means that the era when doctors could guide their patients through the system is probably over. Too often, doctors are turned into what some call “refer-ologists” – trying to quickly assess a patient’s needs and refer them on to the next doctor.
Researchers have been trying to pinpoint the impact of this time starvation on the quality of medical care, and they’re finding disturbing results. A
recent study in the Annals of Internal Medicine found that because of time pressures and related factors doctors deliver “error-free” care as rarely as 22% of the time. The researchers called this a “failure to individualize care,” which is a nice way of saying the doctors just weren’t paying enough attention to the needs of their patients.
Still, it’s hard to be too critical of doctors who end up treating their patients this way. They work in an environment in which they see what must be a blur of patients—hundreds a week. They are increasingly judged by quality metrics that measure their patients as a population,
not as individuals. It’s a combination that encourages
impersonal care, and it is as dissatisfying to doctors as it is to patients.
In my role at Best Doctors, I have seen thousands of members call us for help in making decisions about their health care and navigating their way through the system. As part of our process, we gather data that gives insight about the reasons why people call, the problems they are facing, and how we help them. The results reveal a fascinating look into what it means to be a health care consumer today.
For instance, over tens of thousands of calls in the last year, nearly 60% were from members trying to make a medical decision but weren’t sure what to do. These ranged from people with cancer diagnoses trying to decide on the right treatment, to people who had been recommended back surgery and weren’t sure if it was the right thing to do, to people just trying to figure out what their diagnosis really was. Members describe themselves feeling lost, unsure what to do or even of what questions to ask.
This uncertainty is often a distressing sign of trouble. After being reviewed by Best Doctors, more than 20% of members are found to have something wrong with their diagnosis and more than 60% something wrong with their treatment.
This kind of data closely aligns with an
emerging body of public health literature. These studies show that mistakes in diagnosis happen between 15% and 25% of the time. They also show that top driver of these problems are the cognitive errors – mistakes in thinking – that can be caused by trying to make decisions quickly, with too little information.
So what does this all mean for health care consumerism? It means that in order to be a real health care consumer you have to do much more than shop for price or look for quality. It means you have to be your own strongest advocate. It means you have to make sure that you are satisfied that all of your questions are answered and that you have the right people answering them. It’s not an easy thing to do, but the reality is, you have to do it.
It’s the
kind of advice Dorothy would give you, too.