Today I had a really great exchange with a doctor on Twitter where we discussed a wide variety of things including patients and their ability to know who is a quality doctor. I’d link you to the Twitter exchange, but it seems the doctor has deleted all of his tweets. Not too surprising since he was so anti-social media. Although, I always love when someone engages you on social media to explain why social media is useless (his words, not mine).
The reality is that the doctor and I are aligned on many of the things he said. First, a doctor needs to have their time freed up so that when they’re in the exam room with the patient they can focus on the patient. Many of the things we’ve done in healthcare (including technology) have distracted the doctor from properly caring for the patient. Healthcare IT and EHR software can and should do better.
However, where I didn’t agree with this good doctor was when he asserted that patients know when they have a quality doctor and that great care is provided when doctor and patient have quality time in the exam room.
Let’s start with the first idea. Patients have no good way of measuring if they’ve received quality care from their doctor or not. They certainly can know if they received good customer service. They can evaluate if they enjoyed a doctor’s bedside manner. They can even know if they think their doctor cared about them and their condition. All of these are important aspects of a doctor visit, but they don’t necessarily mean that you received quality care.
A doctor could have amazing customer service, an awesome personality, and still give you awful care. How does a patient know? Most patients barometer is, “Did I get better?” I guess in some ways this is a good measure. However, patients have no idea if they could have gotten better faster if another course of treatment was taken. Patients don’t know if they were overtreated. Patients don’t know if the treatment they received caused some other damage that could have been avoided. Some of them find it out later or have a gut feeling about things, but how could patients know this as it’s happening? If they could know, they wouldn’t need to go to the doctor.
This reality is reflected in all the various physician ratings sites and all of the various quality measures which are thrown at doctors. The best they can do is rate a patient’s customer service experience. The quality measures I’ve seen just create a false or at least misleading impression of what’s really being measured. I have yet to see one that truly measures a physician’s quality. I’m still torn on if it’s possible to measure this.
Now let’s switch to the second assertion, that the key to great care is quality time between doctor and patient in the exam room. Certainly, we all agree that doctors generally can provide better care if they have more time with a patient in the exam room. The above mentioned doctor even tweeted that sometimes what’s needed most is a hug. I agree. Sometimes that’s the case, but not always.
Care is much more nuanced. Sometimes what you need is more time with the doctor. Sometimes what you need is less time with the doctor because you need to get somewhere else or because you suffer from patient trauma and the less time you spend with the doctor the better. Sometimes what you need is a telemedicine visit because the trauma to you or to your family of going into the office is so awful.
Going back to where I started with this post, we do need to free up doctors from all the distractions they experience in the exam room. That will help to improve care. However, that’s not the only solution that’s needed for healthcare to really provide well for patients. A much more sophisticated approach to understanding your patient and catering to their needs is needed. Some of that’s facilitated by technology and some of that is technology enabling a doctor to have more time to create human connections and some of it is humans just doing what they do best.
The future of healthcare is not an either-or world between human connection or technology. The best quality doctors are going to require amazing human connection and healing enabled by and supported by technology.