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Three Antidotes to Patient Depersonalization

— Better patient-provider communication improves quality of care

MedpageToday
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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 or her doctor.

A study published in the Annals of Emergency Medicine found that patient identification mix-ups , especially in emergencies, although they can happen in a . While most are caught early, 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 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 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 of online complaints about healthcare, more than nine out of ten patients were upset over customer service, notably communications and informational shortcomings -- actions often not directly involving the provider.

The Downstream Effects of a Stressed Healthcare System

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 one word: 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.

While the has been popular for two decades and has made the term "patient experience" feel 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, 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 ways 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.

Problem No. 1: 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 such as 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.

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-result notifications (be careful about HIPAA compliance), while others still want to be contacted by telephone.

Giving patients the choice is simply a matter of asking new patients their preference on intake forms, followed by structuring the practice's routines to comply with their requests.

Problem No. 2: Convoluted Pricing and Billing

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. also want to know the cost of their medical care before they receive the service or have the study or the procedure. Two-thirds believe requiring increased hospital price transparency will improve healthcare overall.

In 2009, an 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 of more than 1,500 patients, 25% have skipped a medical treatment or appointment due to the high cost of care, with enrolled in high-deductible plans.

The drive for greater healthcare pricing transparency resulted in federal passage of the No Surprises Act in late 2020, which requires providers to negotiate with insurers in disputes over out-of-network charges. Traditionally, patients have been responsible to pay the extra charges beyond their insurance benefits. But as of January 2022, providers and insurers must leave the patient out of price disagreements and reach settlements either through negotiation or arbitration.

Another cost issue stems from patients' understanding of and confidence in accuracy of medical bills. As many as contain errors. According to the , 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. they would switch providers to access affordable payment arrangements, 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.

Problem No. 3: Replacing Human Interaction With Technology

Overall, the impact of technology in healthcare has been positive. With the implementation of automation, machine learning, and cutting-edge technologies, many providers have made tremendous advancements in the services to patients. But that dependence on technology can also come at the expense of human connection.

The healing process between a doctor and a patient is based on collecting information on the patient's history, including the environmental history, social history, family history, conducting the physical examination, and requesting laboratory tests or imaging studies to narrow the diagnosis and 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.

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.

This 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.

Hence, 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.

Neil Baum, MD, is a physician in New Orleans, the corporate medical officer of , and the author of The Complete Guide to a Successful Medical Practice (Springer 2015).