Eight Rules for a Good Patient Experience

 

How one couple’s harrowing healthcare journey could have been avoided

I’d like to share a recent patient experience that occurred within my circle of family and friends. It demonstrates how a totally avoidable situation wound up sending a couple to the emergency room and cost countless hours of research and doctor visits. We’ll call the couple Emma and Logan.

Emma recently had very minor skin surgery on the ball of her foot. The dermatologist she saw indicated this was really no big deal. Emma was very engaged and asked lots of questions. Notably, she asked whether she could put pressure on her foot. Her doctor said, “You are allowed to put weight on your foot in two or three days or whenever it gets comfortable.”

Sadly, it was challenging for Emma to put pressure on her wounds for two weeks, immobilizing her leg almost totally. Meanwhile, Emma and Logan flew to another state for a weeklong trip, and upon her return, Emma experienced unbearable leg pain. She suspected a blood clot, and a quick online search showed her symptoms matched pretty closely. The couple decided to seek treatment.

Testing for a blood clot is a simple ultrasound. As a reference point, a pregnancy ultrasound typically costs from $50 to $200 and usually includes a 4D video. However, only a hospital ER will do a leg ultrasound in this context. A nearby hospital was quick to process Emma’s paperwork and perform the scan. A half hour later, a physician assistant (PA) reported a deep vein thrombosis (DVT).

Emma asked the PA several important questions, including whether to exercise. The PA responded, “I wouldn’t.”

Logan thought this sounded like an unscientific guess and checked into it. It turns out, the Centers for Disease Control and Prevention, the Mayo Clinic and more all describe exercise as the primary mechanism to dissolve blood clots. Even the literature the couple received from the PA recommended daily exercise and staying as active as possible. In other words, the PA’s advice was actually harmful.

For further guidance, the PA recommended Emma see either a cardiologist or a hematologist. However, Emma and Logan had trouble getting an appointment or even a call back from the two specialists referred by the PA. The couple then called other practices and found clerks either to be unfamiliar with DVTs or demanding all of Emma’s medical records before even revealing how long it would take to get an appointment.

To summarize, the couple had just discovered Emma had a DVT, which can cause fatal suffocation (pulmonary embolism.) Emma’s PA had given advice that could have worsened the situation. Emma and Logan didn’t know who to call, where to go or what to do next.

They only had the internet and a few panicked family members. Emma and Logan sympathize with the unique challenges of healthcare and are grateful for the relatively high-quality care Emma eventually received. Granted, good communication is a difficult skill to master but essential for delivering the best care. Based on Emma and Logan’s experience, I see several lessons for healthcare practices to improve the patient experience.

1. Give evidence & reasoning (if the patient wants it)

Good information will provide better results. Using phrases such as “I wouldn’t” or “I think” or “maybe” or “probably” or sentences that end in a question mark actually signals an opportunity to build trust. It is perfectly reasonable to say that the science is not settled on a particular topic and how you generally guide your patients when there is no universal answer.  When possible, offer to investigate a question and return to the patient later with a better-informed answer.

Give the patient an opportunity to weigh your recommendation with other competing factors, such as their own health history that may not be readily apparent from a brief scan of a health chart. Ultimately, a patient who participates in his or her own health decisions is more likely to follow the plan, accept the outcome, and develop lasting trust in their provider’s care and understanding of their unique situation.

2. Ensure your receptionist is trustworthy

If patients can’t trust the receptionist, they may be unable to trust the doctor. The couple actually found the ER managed to misspell Emma’s name THREE different ways. It’s Emma (not Ema or Amma). The spelling error caused a mistake with the radiologist. When dealing with life-threatening conditions, the risk is too great to excuse mistakes.

As another example, the couple also found receptionists who were too unfamiliar with thrombosis to trust. Consider it akin to calling a restaurant to ask if the salmon is fresh and a restaurant employee asks you how to spell salmon.  No thanks.

3. Present doctor information with patients in mind

Physician biographies on hospital and practice websites should be organized according to conditions and treatments, rather than by merely alphabetical order of physician names and specialty. This helps avoid patient confusion. Patients often search doctor names because they don’t know a doctor’s reputation or which specialty applies

For example, Emma and Logan conducted several internet searches in an effort to determine which doctors might treat Emma’s condition. Once the couple found a practice that seemed to fit the bill, they had to dig deeper to determine if a doctor’s specialty actually addressed Emma’s condition and if the doctor was well reviewed. In this fashion, patients may end up searching a name three, four or more times when comparing doctors and practices.

In other words, a significant portion of doctor search volume may actually be an indicator of patient confusion. Associating doctors with conditions and treatments ensures patients can more readily locate a doctor or practice given a particular diagnosis. Furthermore, it strengthens a doctor’s and practice’s position in search engines. When search engines see that a visitor does not complete their search with your website, the search engine may demote your website in favor of other websites that effectively satisfy the visitor’s question.

4. Translate info for a better patient experience

Translate between medical specialties, conditions, and treatments in both common-English and medical terminology. In the beginning, the couple only had a piece of paper with the words “occlusive deep venous thrombosis.” Patients don’t instinctively know that a thrombosis is a blood clot, or that occlusive deep venous thrombosis means a clot that has shut down an entire vein and is located near the bone rather than toward the skin surface.

In this case, the couple didn’t even have clear direction on what specialty they were needing (cardiologist, hematologist or vascular surgeon). As most people would do, they typed these unknown words into a search engine. If the results of their internet search had instead led to a local doctor who expressly treated DVT, the couple would have avoided a substantial waste of effort contacting practices unable to treat Emma’s condition.

5. Emphasize location on the facility’s website

Spam sites fill massive libraries of junk content in an attempt to sell advertising, drugs and medical tourism. In contrast, personal and localized results make a strong impression. Here’s an example of a spammy website headline: “DVT clinics and treatments.” And here’s an example of a more compelling headline: “Dr. Brown – Denver Area DVT Treatment at Aurora, CO Clinic.”

6. If appropriate, introduce surgery as one possibility

If the patient’s condition warrants it, introduce surgery as one of several possible remedies. Surgery intimidates many patients, especially when past surgery contributed to the problem. When providers promote themselves as the area’s most experienced surgeons, patients can fear they will be pushed toward unnecessary surgery.

Conversely, they will likely be comforted knowing the surgeon is an expert who can also can advise patients on avoiding surgery.

7. Billing complaints may be your practice’s fault, not the patient’s

Consider billing complaints as indicators of the need to address poor organization, not necessarily patient objections to charges. When Emma and Logan were leaving the ER, the receptionist offered to reduce the bill from $300 to $150 for cash payment in full on the spot. The couple was happy to pay and found it consistent with ultrasound pricing for pregnancy.

A few days later, the hospital called to offer financial assistance and indicated that the price actually should have been lowered to $75 from $300 for up-front payment. A week later the couple received a bill from the hospital for $2,700. It is no wonder billing complaints swamp online healthcare reviews. No other profession creates such billing confusion. A hospital’s repeated self-contradiction and absence of consistency is frustrating and frightening for patients.

8. Save work by improving communication

As Emma and Logan eventually learned, blood clots (thromboses) are extremely preventable. Circling back to the beginning, they learned that had the dermatologist more accurately said, “you SHOULD/MUST put weight on your foot as soon as possible and exercise,” Emma wouldn’t have stayed immobilized. The blood clot was unlikely to have formed.

Better information would have saved a tremendous amount of anxiety and thousands of dollars worth of treatment and time, ongoing scans and complications.