Three ways to stop depersonalization, which can undo all intentions to provide patient centered care
This article was originally published in MedPage Today, November 30, 2021
Imagine going to the doctor for your annual checkup and the physician pulls out a chart or looks at the EMR of a different patient. Or picture the doctor discussing medications you’re not taking and the results of tests you never had. These egregious mistakes would certainly not endear a patient to his/her doctor.
A study published in the Annals of Emergency Medicine found that patient identification mix-ups can happen easily, especially in emergencies, although they can happen in a variety of clinical settings. While most are caught early, nearly 10% cause harm to patients, according to ECRI (originally the Emergency Care Research Institute).
For example, among the most serious mistakes uncovered in the ECRI study was that of a healthcare team not attempting to resuscitate a patient in cardiac arrest because team members had pulled up the record of a different patient with a do-not-resuscitate order.
Clinical mistakes quickly diminish a patient’s confidence in his or her physician and fuel a motivation to find a new provider. From my decades-long experience of practicing urology, I can attest that building patient trust typically takes years, yet it takes just one problem or unpleasant experience to undo that hard-earned trust. Unfortunately, frustrated patients often place the blame on the physician – even when it’s not the doctor’s fault.
In fact, research has indicated that quality of care is the cause of patient dissatisfaction less than 10% of the time. In a study of online complaints about healthcare, more than 9 out of 10 patients were upset over customer service, notably communications and informational shortcomings – actions often not directly involving the doctor.
Downstream effects of a stressed healthcare system on patient depersonalization
As I see it, insufficient communications and information sharing with patients – as well as misidentification – are leading toward a crisis of confidence that can be distilled into two words: patient depersonalization. Stresses and strains on our healthcare system are not only leaving providers overwhelmed and overworked, they are also rendering individual patients with a sense of not mattering, of being reduced to faceless, unnamed widgets rolling down the healthcare factory’s assembly line.
Dismiss the patient experience at your own peril
While the experience economy theory has been popular for two decades and has made the term “patient experience” seem like a cliché to many healthcare professionals, our profession is encountering its effects with more force than ever before. Modern patients are demanding copious information and prompt communications even when they’re not in the office, such as on the telephone or on a virtual visit.
Given today’s distractions from clinical medicine, we are tempted to throw our hands in the air and bemoan the fact that medicine isn’t what it once was.
But not all is hopeless. There are efficiencies to enhance the patient experience and build patient confidence merely by identifying and revising outdated routines and procedures.
In my experience, the key to personalizing healthcare lies in addressing three common sources of patient depersonalization and dissatisfaction.
It takes a long time to earn patient loyalty, and it can all vanish with just one depersonalization experience.
Patient depersonalization fix #1: End cookie-cutter patient communications
Nothing is more personal than health. Highly personalized medical practices produce patient information that addresses individual needs. Generalized, templated mail or email messages don’t suffice. Patients delete or ignore these blanket communications.
A better, multifaceted approach provides an integrated patient experience through various channels, including e-newsletters, text, and chat, all of which can be at least partially automated and easily managed with a variety of software options.
For group communications, providers can identify a few specific segments of their patient base – via broad categorizations by, say, age group, gender, health history and family status – and develop a communications plan for each. There are electronic medical record systems that permit sorting and analysis by such classifications.
Offer text message, email & phone methods for patient communications
As for individual communications, the better approach to personalization allows patients to choose how they interact with providers and the practice. Many patients prefer text messaging or encrypted email for test-results and appointment notifications these days (careful about HIPAA compliance), while others still want to be contacted by telephone.
Giving patients the choice is a simple matter of asking on intake forms as they become patients, followed by structuring the practice’s routines to comply with their requests.
Patient depersonalization fix #2: Avoid convoluted medical billing & pricing
Would you ever consider staying at a hotel, booking an airline ticket or buying an automobile without knowing the price before you made your purchase? Probably not. Nine out of ten Americans also want to know the cost of their medical care before they receive the service. Two-thirds believe new federal legislation requiring increased hospital price transparency will improve healthcare overall.
Growing healthcare price transparency
In 2009 an Oklahoma surgery center set off a local price war and drew national attention by posting prices of their services online. Their fees were typically a fraction of competitors’ charges. (In a controversial move, the center sidestepped federal regulations by not taking Medicare and Medicaid.) Patients flocked to the surgery center. The group now includes 43 providers in a dozen specialties, while many other practices locally and nationally have followed suit.
Price transparency becomes more critical as rising co-pays, deductibles and insurance premiums are passing financial responsibility to patients for their medical care. According to a poll of more than 1,500 patients, 25% are avoiding care due to its high cost, with nearly half of Americans enrolled in high-deductible plans.
Another cost issue stems from patients’ understanding of medical bills and confidence in their accuracy. As many as 80% of medical bills contain errors. According to the Healthcare Financial Management Association, patients are most satisfied when they can understand how charges were calculated, how much will be the patient’s responsibility, when payment is due, and who to call with questions.
Finally, patients want affordable payment options. Two out of five say they would switch providers to access such plans, including half of households with children. This means more providers must be prepared to accept automatic monthly payments for large balances before they become a collection issue and harm the doctor-patient relationship.
Depersonalization fix #3: Don’t replace human interaction with technology
Overall, the impact of technology in healthcare has been positive. With the implementation of automation, artificial intelligence (AI), machine learning and cutting-edge technologies, many providers have made tremendous advancements in the services for patients. But that dependence on technology can also come at the expense of human connection.
The healing process between a doctor and a patient has for the past 2,500 years been based on collecting information on the patient’s history (including the environmental history, the social history and family history), conducting the physical examination, and requesting laboratory tests or imaging studies to narrow the diagnosis (or provide a differential diagnosis) and a hierarchy of diagnostic options. The doctor mentally ranks or prioritizes the options and then initiates treatment for the patient.
This method has worked for millennia. But today’s patients are demanding innovations. The COVID-19 pandemic exploded the use of telemedicine. Now it is acceptable and even safe to provide care in certain instances without examining the patient.
Balance healthcare AI with a human touch
In another example a new AI-powered diagnostic program can collate and summarize for the doctor tens of millions of similar cases, including the most recent publications in thousands of medical journals. This advancement makes it possible for the clinician to spot the zebras amongst the horses.
The AI tool can make any doctor a super diagnostician without having to send the patient to a super tertiary center to obtain a diagnosis even when patients have rare diseases or conditions. At the same time AI still allows doctors to employ instinct, skills and experience to override the AI evaluation.
But for all the wonders of technology, a successful patient interaction must balance technology with human judgment and personal touch. Technology becomes an asset to augment the patient experience, not a distraction from it. It is unlikely that computers, algorithms or Alexa will replace physicians, as long as providers focus on connecting and enhancing communications with patients.
It takes a long time to earn patient loyalty, and it can all vanish with just one depersonalization experience. Conversely, a modicum of increased personalized communication and transparency, along with maintaining personal interactions, can cement invaluable physician-patient relationships and patient loyalty lasting a lifetime.