Patient's Perspective In Healthcare - Part 4

To finalize this topic of a Patient's Perspective In Healthcare, I have decided to focus on the effects of pharmaceutical company’s power to influence Congress, the cost of health care, and the way doctors treat their patients.

Pharmaceutical companies since the late 80’s have had a tremendous influence on how Congress passes legislations and how doctors treat patients. Because pharmaceutical companies have billions of dollars they lobby parties in Congress by “donating,” but usually for something in return. It is amazing how many alternative medications do not get passed, that can be less harmful, more effective and less costly, because it puts large pharmaceutical companies at risk of losing a buck.

Therefore patients pay the price of using medication with more side effects, and that cost more or are less effective. It’s not fair. Many of these drugs cause other medical condition, which only adds to the pockets of the pharmaceutical companies. A balance should always exist, especially if it’s for the best of the American people.

Secondly, pharmaceutical companies have a close grip on the way doctors treat patients. We have heard the new in Florida of the large “pill mill” bust. And it’s no surprise. Doctors get paid incentive to push certain pain medication.

Many patients go to physicians because of medical condition that is causing them pain. Many of these doctors before even providing a complete diagnosis prescribe opiates that are powerful and addictive. So now, we see ourselves with a new market of pain medication addicts, which could be anyone. It could be your mother, your sister, your priest, your daughter, or you.

I am an example of what could have been. In late 2008, I went to the doctor because of lower back pains towards my kidneys… These were strong pains. When I went to the doctor, I was seen by a rather new physician in the office. I explained my symptoms, and she asked me to get some tests done to see what was going on. During that same visit she prescribed me some pain medication – before knowing my actual medical condition/diagnosis. I took my prescription to the pharmacist and got my drugs. When I came home I explained to my husband what the doctor had said and what she prescribed. He became angry and told me to throw away the pills. He explained that “Percocet’s” where extremely addictive and unless I was dying, I should not take it. He further explained that his aunt had overdosed accidently at the age of 32 due to pain killers such as these. I then took my Tylenol and my pain eventually receded.

 
Well, not only did I get a prescription for a drug that is highly addictive, my doctor never explained much about the drug. And when typically a patient gets prescribed a couple of pills, my prescription was for 90 tablets.

Consequently, from a patient’s perspective the “quality” of healthcare is being influenced too much from the invisible hand of the pharmaceutical companies. Our Congress should protect its citizen and not put them at harm’s way. If these measures were taken more at heart, we would have more reasonable healthcare costs, and more adequate care.

Patient's Perspective of Healthcare - Part 3

   

It is very interesting to me how a patient’s perspective can change or just be different due to the type of insurance they have.

I read the story of a man that went into the emergency room with chest pains, and after several tests, all of them came back normal. As standard procedure they kept him overnight for observation. The next morning he just though they would assumed that he would get a stress test “but the cardiologist on duty, looking at his history of high cholesterol (even with medication), his age (46), and the way he presented himself at the hospital, and decided he wanted to see what was going on inside. So he opted for a more invasive-and more expensive-approach: angioplasty” (Atlas, July 2009). The results came in and the doctor discovered that ‘he had two severely blocked arteries and within a week's time he underwent two surgeries, receiving a total of three stents; and is now on a host of new meds and have started cardiac rehab – all covered by his insurance (Atlas, July 2009).

What if he did not had had insurance? Because all test came back normal, and under EMTALA law, he would have been released and sent home. Perhaps he would just have been given a recommendation to see a cardiologist for a follow-up. Then, the outcome would have been very different. He could have suffered a heart attack, and probably suffered other medical consequences such as: a coma, infection, stroke, maybe even death.

So, my question is, how do we judge our quality of care? It’s so difficult to know when patients lack the knowledge on what would be the best approach to a specific scenario. We put all of our faith on a medical team that might not always put forth the “Art of Medicine” to play, when money is involved.

The same applies to patients with Medicaid and Medicare. Their course of treatment could be quite different due to their method of payment, as Medicaid and Medicare have guidelines that restrict certain more expensive, yet more effective procedure, without yet using other less expensive alternatives. Therefore, changing the outcome of treament and the patient's persepctive of quality.

Patient's most effective course of action should be the motto - no matter payment method, because they are at the end with their life and health on the line.

References:

Atlas, Pierre. (July 2009). A Patient's Perspective on the Health Care Debate. Real Clear Politics. Retrieved July 10, 2011, from URL: http://www.realclearpolitics.com/articles/2009/07/31/a_patients_perspective_on_the_health_care_debate_97717.html

What Quality Means to Me - Part 4

What does quality mean to me?

After my grandmother passed away at the age of 89, I was left with many questions.

On June 10th, my grandmother suffered a brain aneurism. During her hospitalization, surgeons inserted a tube into her skull to assist with the release of pressure and drainage of blood. We were told her chances of survival was less than 5%, especially due to her age.

Then we were told that little by little her body would begin develop infections and fevers, which is the normal course of her situation. As predicted, my grandmother began to have slight fevers, and after a day of no real change -just a few signs we thought were positive, but the doctor reassured us, it was nothing - we decided to take her off the machines and not prolong her painful situation.

Well, after doing my MRSA project I began to question the reason for the infections. I began to question the environment that my grandmother was in; I began to question the statistics.

I began to question why she was in an area that was open to other patients, if she was so delicate. I wondered, why they allowed just anyone to come and see her, as long they came in groups of 2; but after 3 days they said nothing when groups of 4 or more were around her to see and pray for her.

Then I began wondering, why they did not regulated the environment she was in by requiring gloves and robes to minimize infections and contamination, especially if she had a tube coming out of her brain?

I began to ask why no one did or said anything about this, or enforced any visiting code, to better protect her and increase her chances of survival?

These questions remain unanswered…. And to me quality means having no question unanswered? Knowing how we got from point A to point B, and know that every possible resource and prevention method was implemented and supervised to maximize health outcomes is the meaning of quality.

Emelie Bahamonde

What Quality Means to Me - Part 3

Health care quality means to me many things. After doing a research project on Methicillin-ResistantStaphylococcus Aureus, more commonly known as MRSA, I have realized how vulnerable we are as patients.



MRSA is an infection that is highly contagious and extremely devastating to those that get it. But what shocked me the most is the lack of preventive measures such as “awareness and education” to patients and medical staff, from the health care industry. I just recently gave birth to a baby girl, and not even once was given any literature on MRSA, and how it can be passed on to patients or from patients.



Too much trust is being given to health care organizations (HCO’s) and physicians on the wellbeing and fast recovery of patients, when a large percentage of these infections are being transmitted through the hospitals. Either because of poor environmental sterilization, poor use of antibiotics, poor supervision, lack of resources on items such as: gloves, robes, etc. (Siegel, Rhinehart, Jackson, Chiarello, 2006).



I walked out of mother-in-laws nursing home two weeks ago, and when I went to clean my hands with hand-sanitizers at the door, it was empty. This is what I mean by how vulnerable we are when we rely too much on HCO’s. This is what health care is about to me. About providing all preventive measures to patients and medical staff, etc. to maintain health in our community.



A patient hospitalized with MRSA has a medical expense 110% higher than one ; and who pays the majority of the bill (besides self pay patients)? Taxpayers, through Medicaid and Medicare (AHCA, July 2009). They swallow 71% of the charges, which in 2007 amounted to $2.591.292.8886 (AHCA, July 2009).



In conclusion, quality of care is more than getting the right diagnosis, and the right attitude and information from your provider, it is knowing that they are doing all the right things, and that you are not vulnerable to their mistakes, and left with a large bill to swallow.





References:

AHCA. (July 2009). MRSA in 2007 Florida hospitalizations. Statistical Brief. Florida Center for Health Information and Policy Analysis. Florida Agency for Health Care Administration (AHCA). Retrieved July 5, 2011 from URL: https://floridahealthfinderstore.blob.core.windows.net/documents/researchers/documents/MRSAbrieffinal.pdf

Siegel, J. D., Rhinehart, E., Jackson, M., & Chiarello, L. (2006). (Unites States, Centers for Disease Control and Prevention, Healthcare Infection Control Practices Advisory Committee). Retrieved July 10, 2011, from http://www.cdc.gov/ncidod/dhqp/pdf/ar/MDROGuideline2006.pdf

Patient's Perspective In Health Care

  

s we go into more details about what patients want, we ask ourselves what patients are using as basis to pinpoint their "patient satisfaction." Patient Surveys tells us that patients are looking at the following factors:

a)      How often did nurses communicate well with patients,

b)      How often did doctors communicate well with patients,

c)      How often did patients receive help quickly from hospital staff,

d)     How often was patient’s pain well controlled,

e)      How often did staff explain about medicines before giving them to patients,

f)       How often were the patients’ room and bathroom kept clean,

g)      How often was the area around patients’ rooms kept quiet at night,

h)      Where patients given information what to do during their recovery at home (U.S.HHS, 2011).

      So, not only are patients telling us that what they need when it comes to medical assistance, through these surveys, patients are telling us what is important to them; and doctors and leaders need to listen up. Now on the other hand, there are many doctors that are taking the initiative and are seeing the “light” of what engaging with your patients and customizing services to their patients needs can accomplish: more patient retention, more referral and more pay, thus more revenue.  Howeve, we are also seeing an increasing trend of doctors that use this as a strategic advantage.  By focusing primarly on the “patient satisfaction” aspect of medical care, they are being more selective on who they see, and who they refer.

     In a report done by healthLeaders, and commented by KevinMD, “Already, more than 80% of doctors said patient pressure influenced their medical decisions. And in primary care, linking bonus pay to patient satisfaction could cause physicians to be more selective in who they see, subtly keeping patients who they know will score them well, and referring disagreeable ones to other providers” (KevinMD, 2011).

     So, now we have the irony that if you are not a well satisfied patient your are not "good patient", and physicians will send you elsewhere. Here I see an ethical dilemma. What comes first? Patient’s perspective on satisfaction vs. medical service perspective. In other words, if we completely focus on what the patient says, do we compromise the medical quality of care and the access of care?

     This is a great question to debate, because it tells us what we can expect if the wheels turn completely.

     There has to be a balance. For example, if a patient constantly feels the need for prescription drugs, should a doctor deny this, even though the drug could “control the pain well” (see patient satisfaction survey question “d”). So, I see that a balance must be met. Patients should be also educated enough to see the line between good medical care and bad medical, and good patient focus care and bad patient focus care; because if not, we risk losing care from excellent doctors, because of our uneducated patient perspective.

References:

KevinMd.Com. (2011). Op-ed: Patient satisfaction doesn’t mean the best medical care. MedPageToday’s. Retrieved June 26, 2011 from URL: http://www.kevinmd.com/blog/2010/04/oped-patient-satisfaction-medical-care.html

U.S. Department of Health & Human Services (2011). Survey of Patients about Their Hospital Experiences Graphs. HHS.gov. Retrieved June 26, 2011 from URL: http://hospitalcompare.hhs.gov/Graphs/hospital-Graph.aspx?hid=100007,100006&stype=GENERAL&mCode=HCAHPS&graphState=FL&tab=HCAHPS

"Service Serves" - Patient's Perspectives Feeds The Bottom Line

A patient’s perspective in the quality of healthcare is a vital part of an organization’s success. Enhancing a patient’s perspective on the quality of care they have received is an investment. It brings “greater profitability; improved customer loyalty and increased referrals; it teams staff towards a common goal, brings positive staff morale, retention, and recruitment benefits; and brings strong community support” (Michelli, 2011, p. 225).

In fact, empirical evidence gathered by UCLA’s health system says: 1) “Even in difficult times, 50 percent of consumers will pay more for a better service experience”; 2) “A full 68 percent will sever a customer relationship because they were treated poorly”, 3) “companies that are successful in creating both functional and emotional bonding with customers have a higher retention rate (84 percent vs. 30 percent)”, and 5) “The cost to attract a new customer is 6 times the cost to save one” (Michelli, 2011, p. 227). An even stronger finding was that out of all the patients that leave a provider for poor quality, only 15% reported it was due to “product” reasons; in other words, 85% left because of poor service (Michelli, 2011, p. 226).

So then we ask ourselves, if patients play such an undeniable role in a physician’s success, what keeps them from centering they mission towards “patients”?  In the book Prescription for Excellence, it states that “the healthcare industry has lagged in accepting this concept for several reasons:

“Customers are not loyal in the traditional sense because they usually wish to avoid using the healthcare system except when necessary”

“Most customers are insulated from price due to health insurance, and often fail to care about cost, only wanting the best, newest procedures”

“Clinical care is often viewed by physicians as completely separate from traditional customer or administrative services’

Clinicians believe great medicine will gain forgiveness for poor service” (Michelli, 2011, p. 228).

However, what these healthcare organizations and physicians do not grasp is that ‘word of mouth” is a powerful tool that can either make you or break you. A patient’s perspective not only influences his/her behavior, it can tarnish another’s. One example, was when I was getting ready to have my first daughter Amelia, I really wanted to deliver at Hospital X vs. Hospital Y, because of its new facility, great food, and the best in technology. But, one day when discussing my options to a person I met, she advised me to not deliver at Hospital X, to instead go to Hospital Y because of poor customer service. I had changed my plans to deliver at Hospital X, until the last minute I had a change of heart. I wanted to give Hospital X a chance of my own, and I did not regret it. But, my perception was altered (at least temporary) by word of mouth, and it could of cost Hospital X, two (2) deliveries of my own, and many referrals from me.

When leaders put focus on delivering quality service with the patient’s perspective in mind it brings staff together. Employees become engaged when they feel that their contribution is substantial “The mission/purpose of my company makes me feel my job is important” (Michelli, 2011, p. 236).

             In conclusion, a patient’s perspective is a key role in any organization. In healthcare, it was will make success sustainable without limits.

References:

Michelli, Ph.D, Joseph A. (2011). Prescription for Excellence. McGrawHill. Co-published with Second River Healthcare Press

What Quality Means to Me - Part 2

 I have been reading an excellent book "Prescription for Excellence" by Joseph A. Michelli. This book talks about how UCLA Health System (UCLAHS) has become a top tier medical institute due to their commitment to care, which breaks down into five different principals: " 1. Commit to Care, 2. Leave No Room For Error, 3. Make The Best Better, 4. Create The Future, and 5. Service Serves Us" (Michelli, 2011).

From an HSA graduate student perspective, the combination of these 5 principals is an excellent example of what quality means to me, and should mean to all health care systems. Quality in a successful health care system required "the innovation of Apple, the commitment to safety of NASA, and the customer service of Ritz-Carlton" (Michelli, 2011, pg. 1). This approach has worked for UCLAHS, and I ask myself are all hospitals as committed to these principals as UCLAHS? and if not, why not? How will they survive, in a market where customers (patients) are becoming self aware and more educated on their health and health care.

From an HSA student perspective, quality is understanding that every aspect, every personnel in a health care system contributes to the outcome "customer/patient satisfaction". That each department, each staff member, each procedure matters in providing the quality of service that patients require and demand, because ultimately "Service Serves Us".

Reference:

Michelli, Ph.D, Joseph A. (2011). Prescription for Excellence. McGrawHill. Co-published with Second River Healthcare Press, pg. 1