What Patients Really Want: Poll Results
We always learn a lot when we ask people to provide us with their input, rather than making assumptions about what they want, and there was so much to learn from my most recent poll, in which I was interested to know how people felt about the terms “patient,” “customer,” and “consumer.”
Patient vs. customer vs. consumer
We live in a time of growing consumerism, but does this really apply to health care?
We had 138 people who identified themselves as a current or past patient take part in our recent survey.
Of that survey population, 53 percent preferred to be thought of as a patient, 6.5 percent preferred to be thought of as a customer, and 14.5 percent preferred to be considered a health care consumer.
About a fourth, 26.1 percent, did not have a strong feeling regarding the terms used.
And while these were their preferences, fewer than 20 percent were offended by being labeled a customer or consumer.
We had at least 22 physicians take the survey. Five physicians found it offensive to think of a patient as a customer, and one found it offensive to think of the patient as a consumer.
What does this tell us?
First of all, I think these results support a growing sense among patients that they are also customers or consumers and have choices. In the past, the medical record was the physician’s; today, it is the patient’s.
Today, patients are interested in accessing their medical record online. And more and more studies demonstrate that patients are willing to change physicians to meet their needs. In the past, patients might have expected to have the same physician for their entire life unless they moved or their physician retired.
More than a quarter, or 27 percent, of physicians who responded to our survey felt it offensive to think of a patient as a customer or consumer.
Why would that be?
Perhaps it commercializes the physician-patient relationship in their minds. Perhaps it is hard to abandon the physician-centered past, when patients were willing to wait days for an appointment and hours in the waiting room.
Perhaps it is difficult to admit that patients are increasingly willing to be seen in retail clinics, or participate in online visits, or even travel across the country or out of the country to undergo surgical procedures that are less costly.
What do patients want, and what are physicians providing?
Of the survey choices we provided (same-day appointments, after-hours availability, weekend hours, ability to email physicians or other health care providers, and ability to access medical records online), ability to access medical records online was of the greatest importance, with 85 patients indicating this was “very” important and 37 indicating it was “somewhat” important.
The next most important service was ability to email physicians or other health care providers, with 75 patients indicating this was “very” important and 34 patients indicating it was “somewhat” important.
In descending order of importance were same-day appointments (66 “very” important/60 “somewhat” important), after-hours availability (42/64), and weekend hours (28/55).
Of the physicians that responded to our survey, 13.6 percent offered the ability to access medical records online and 9 percent offered the ability for patients to email them or their nurse practitioner or physician’s assistant, the two services of greatest importance to patients.
Of our survey population, 18 percent of the physician respondents offered same-day appointments, 23 percent offered after-hours availability, and 18 percent offered weekend hours.
What does this tell us?
There is a mismatch between what patients say they want and what physicians are providing. Could this be a result of failing to look at patients as customers and/or consumers? Will patients leave their current physician for another physician who does offer these services? Some of the studies I have seen suggest that some patients will.
But our survey shows that physicians are catching on. The 22 physicians who responded all indicated that they began offering one or more of these services to attract new patients or retain existing patients.
How do patients make health care decisions?
The overwhelming majority, or 95 percent, of the patients who answered reported that they selected their physician and hospital based upon recommendations from friends and family. That said, 43 percent also considered health care rankings and awards.
It probably shouldn’t have surprised me, but it did: 34 percent of our patients reported online reviews influencing their choice of physician and/or hospital.
Another surprise was that, for all the media coverage and advertising, those factors influenced only 16 percent and 7 percent of patients, respectively. And 25 percent indicated that hospital and physician websites influenced their choice.
The final surprise – as many patients were influenced by physician or hospital social media as advertising!
In all, 54 percent of patients occasionally visit medical websites or conduct other online searches for medical information, but 40.6 percent do so frequently. Only 5 percent of patients did not use online sources for medical information. When patients did access online medical information, 30 percent said it frequently influenced their treatment decisions and 62 percent indicated that it occasionally influenced their treatment decisions.
What we heard
We asked patients and physicians to give us their thoughts as well. Here are some of the comments respondents provided.
Patients
Do you have other thoughts on how health care providers can improve your health care experience?
The most frequent recurring comments were, “Be respectful of my time” and “We love myChart!”
Other comments included:
- The ability to email providers is an excellent service.
- Save me from having to make a visit when the visit is not necessary.
- Decrease the number of times I have to repeat the same information.
- Have more triage options so I can ask questions to determine whether I need to come in to see the doctor.
- Offer treatment options by a neutral department/provider who is well informed but without a vested interest in the treatment options.
- Make me feel like you are not in a rush.
- Answer all my questions/concerns.
- Let me know when I can expect lab and other test results to be available and how I can access the results.
- Educate me as to how I can be a better patient.
- Educate my caregiver on how they can be a better partner in my care.
- Listen, listen, listen.
- Be warm, friendly, and honest.
- Quit limiting or refusing to see Medicare and Medicaid patients.
- Return my phone calls before the end of the day.
- Weekend hours would be desirable.
- Look at me when you talk to me, not the computer screen.
- Treat me as a partner in my care, not in a paternalistic manner.
- Coordinate my care with my other physicians.
- My patient experience is affected by everyone I interact with, not just the physician.
- I want to know that all my caregivers have access to my health information.
- Let me see and pay my bill online.
- Don’t talk down to me.
- Always provide an after-visit summary.
- Always protect my privacy.
- Keep the cost down.
- Providers need to get comfortable with the fact that patients are customers who can take their dollars elsewhere. You wouldn’t go back to a restaurant where you wait an hour to be served, an hour to receive your meal, and an hour to get your bill, yet this is common culture in health care. Efficiency is going to hit this industry hard as my generation starts to consume more and more health care. I want to email my doctor and have him respond. Better yet, let me Skype with my doctor/PA/nurse.
Physicians
Do you have other thoughts on how physician and patient relationships have changed?
- We offer weekend hours, same-day appointments, and evening appointments because it is the right thing to do for patients, not necessarily because it is “good customer service.”
- There is a strange juxtaposition between patients wanting to “spare no expense” in working up a problem they have and wanting to reduce health care costs.
- It is less about quality and more about perceived level of service.
- Patients want more for their health care dollars.
- Patients want more accessibility, communication, and follow-up.
- Patients are increasingly focused on prevention.
- More patients are inquiring about alternative or complementary medicine.
- We are going to be held more accountable for the care we provide and preventing problems before they start.
- Although I don’t use the term “customer,” I emphasize patient-centered care.
- Patients are coming in more informed and have information from the Internet.
Upcoming Summit and special speaker
And with all of this in mind, we have a special guest planned for our St. Luke’s Health System Summit next month – e-Patient Dave.
Dave deBronkart, whose personal experiences with cancer treatment spurred him to become a patient activist and advocate, also will be a guest blogger here in this space. And we’ll record Dave’s talk at the Summit and make that available through my blog.
You won’t want to miss either his post or his video; they’ll change the way you think about patient care.
Thanks to everyone who took our poll! You’ve given us a lot to think about and to work on!
Tags: accountable care, best practices, Dr. David Pate, Dr. Pate, electronic health records, electronic medical record, st. luke's, St. Luke's Health System
I think we still have a ways to go in a lot of these areas.
The primary area I think needs to be looked at is the system that rewards doctors for how many patients are seen and what tests and procedures are ordered. Of course your doctor doesn’t want to email you or Skype you. He isn’t getting any benefit for this, other than a warm fuzzy feeling. Warm fuzzies won’t pay off student loans or make the house payment. RVUs are where it’s at, right?
On the flip side, when I have a simple question, I don’t want to pay $150 just to be told take some Tylenol and get some rest. Sometimes people just need a little pat on the back and reassurance that they are OK.
I know that I’d hate to tell somene not to come into the clinic and have something bad happen right after, and I am sure that doctors feel the same way. You can’t diagnose someone effectively over the telephone or Skype. Telemedicine is a boon where you can’t normally get care, but not appropriate to just avoid a trip to the doctor.
The hardest part is reconciling what people need and want, and what health care can give them. I think it takes a strength of character to be a doctor, one that most people lack, including myself. The idea that people’s heath depends somewhat or all on my advice would be frightnening, especially not knowing what might be critical or not. I will stick to machines, I think!
Arnie
IT
St. Luke’s EOMA
Baker City
Dr. Pate,
I am one of the people who objects to use of the term “consumer” when it comes to my medical care.
Why? Because consumers have choices and make decisions about the right choices for them. As a patient, I have few if any choices when it comes to selecting which providers, hospital, and testing labs, or any other aspect of my care, because I am limited (hamstrung?) by my insurer.
If I want to be a true consumer, I need to have a full range of choices, and I need to be in the decision-making driver’s seat. Too many providers consider the patient who wants to be the decision-maker to be a difficult patient.
Further, too often patients don’t even know what their choices might be when it comes to testing or treatment.
Here’s an example. Few, if any, providers ever tell a patient that one of his choices for treatment is to do nothing at all. Patients are railroaded every day into tests and treatment they would never choose if they stepped back to think about it. Even if they do think about it, they are often too intimidated to speak up because, again, they will be labeled “difficult patients.”
For these and a dozen other reasons, when it comes to medical care, patients can’t ever truly be consumers, because every aspect of the system limits the real consumer-type choices we have.
To be a consumer, I have to be in the driver’s seat. And that possibility is still way too rare.
No. I am a PATIENT.
Trisha Torrey
Every Patient’s Advocate
P.S. You’ll love hearing Dave speak. He does a great job.
Hi, Arnie!
Great comment! First of all, I am glad you are sticking with your current profession. We need you!
You really have identified some of the key issues. On one hand, patients want greater convenience, lower cost, and access to their physician through email, Skype or other alternative means when they have questions or a “simple” problem.
On the other hand, physicians don’t get paid under traditional insurance for emails and Skype visits, and yet they retain the malpractice risk if this “simple” problem actually turns out to be something serious.
The important lesson for health care providers is this. The intersection of unmet needs on the part of a consumer and a current business model that cannot flex to accommodate to those needs gives rise to disruptive innovation, especially when the unmet need is for lower cost services (e.g., office visits vs. hospital care) and there are many who would like the new service but cannot afford it in the current business model (a problem that clearly exists in health care).
This is what has given rise to so-called retail clinics (the clinics in a pharmacy often staffed by a nurse practitioner) and to many new companies that offer online physician visits.
In the current business model, those physicians who are willing to find some balance and to offer these services that meet unmet needs will gain patients from those physicians who are unwilling to do so. Unless a sufficient number of physicians in the market are willing to meet these needs, then the disruptors will come in and they will take this part of the market away from physicians stuck in the current business/care model.
I am convinced that the new business model St. Luke’s is pursuing will create entirely new insurance products that will allow us to incorporate all these services into our care model and in fact, reward us for doing so.
Patients will like it better, but unlike the products offered by current disruptors, care will be better coordinated as opposed to further fragmented, since disruptors cannot offer accountable care that achieves all parts of the Triple Aim of better health, better care, and lower cost in a care model that spans the continuum of care.
Thanks for following the blog, Arnie, and congratulations to you and all the staff at St. Luke’s EOMA for the national recognition you all are achieving! You all make us very proud!
Hi, Ms. Torrey.
Thank you for joining the conversation! I love it that my blog has interested patients and that patients are willing to help us learn from them. And we are so excited to have e-Patient Dave at our Summit this year!
I think you make some very good points. To further our discussion, let me change up the question. I understand that you feel thwarted in being able to be a consumer. What would you like to be, a patient or a consumer, and how do you want your physician to think of you?
If I am understanding you, it seems that you feel you are a patient by the circumstances of your insurance plan design and by the fact that your physicians do not engage and empower you in your own care. I sense that you want to be a consumer, but feel locked in to being a patient.
If that is the case, what are you willing to do about it? Would you consider changing insurance plans? If that is not feasible, would you be willing to change physicians within your plan?
If neither of those are options, are you able to relocate, and would you do so based on your health experiences? We’re doing ground-breaking work in our region, which has great health plans with low premiums relative to the rest of the country. And St. Luke’s has great physicians who are embracing patient-centered care, not to mention our journey to continually increase the value our patients receive, while lowering the costs.
Thanks for following the blog and thanks for writing in with your comment.
Hello, Dr. Pate, and thank you for addressing patient/customer/consumer preferences.
It’s a surprisingly complex topic, but you’re reaching out and engaging your health care community so that St. Luke’s can continue to improve on the health care you deliver. It’s not an easy process, but I think you’re doing a terrific job, and I really appreciate your efforts and the progress you’re making.
A comment about the survey: As an advocate for our senior citizens, I’m especially interested in the age distribution of the respondants. Specifically, I’m wondering how the responses of seniors compare with those of younger folks.
In general, I believe that seniors (65 years and older) are an underserved and underrepresented demographic, even though they are quickly reaching 20 percent of our population, have the most chronic illnesses, and consume most of our health care dollars. They generally don’t take surveys, they don’t use computers much, they don’t have smart phones (or if they do, they don’t take advantage of the latest developments in technology). And you’d probably have to tell e-Patient Dave to speak up a bit as many seniors might have trouble hearing him!
All these things and more demonstrate that seniors interface differently with our health care system that younger folks do.
Thanks again, Dr. Pate, for engaging our community and discussing these important topics.
Hi, Dr. Fuller.
Thanks for your comment and for your kind words of encouragement.
You raise a great point and unfortunately, I did not think to ask people to indicate their age (my HR leader is probably beaming with pride to see how well she has trained me to never let age cross my mind!) so that we could segment them by age to see if there are any generational differences. I would not be surprised if there were, but my impression is that the senior group is fairly diverse.
As you know, we just had twin grandchildren. Their great grandmother, my mom, called me from Houston and told me that it was my job to make sure that she and her great-grandchildren could connect by Skype the night they were born! I had never skyped, if that is a proper verb. And e-Patient Dave is no spring chicken (no offense, Dave!
) but has started a national movement by tapping into the power of the Internet and social media. I think you have just given me the idea for my next polling question!
Thanks for your comment and for following my blog, but especially for being a part of our discussion!
I’m interested in perspectives concerning medical insurance. The truth is that medical insurance should be for catastrophic health issues, like our car insurance is for accidents and the like. We no more expect our car insurance to buy our gas, fix our flat tires, or change the oil, yet if medical insurance does not pay for a service, the patient feels that it is not worthwile or will blame the physician for ordering the service.
The real issue is that we no longer truly know what health care costs. To a patient, a visit to my office is only worth $25, the price of the co-pay. The true cost of health care is hidden in employee benefits packages that they never read. Everyone wants the fastest, easiest, cheapest, and best personal health care and does not see the value of actually paying for the service!
Furthermore, we have the advent of insurance companies directly advertising to patients. UHC’s “78,000 people taking care of 78 million Americans” comes to mind. We would do well to remember that these companies’ primary responsibility is to make money for the shareholder, not to care for patients buying the products.
The care comes from the health care professional. And what happens when that professional is working in a clinic owned by an insurer and has only limited options for testing, prescriptions, etc., and must follow strict guidelines based on treatment algorithms that are engineered to reduce costs? You get “providers” (doctors, APRNs, PAs, nurses, etc.) practicing cookie-cutter medicine in 10-minute increments for faceless patients.
I for one choose to believe that the art of medicine includes such revolutionary thinking as actually knowing your patients, their lives, families, joys, and sorrows. I will educate them about the options available, and assist them in choosing one that works for them.
I will give them my undivided attention in an unhurried atmosphere while I teach them about the importance of their health and body. I will enlighten them that medical insurance is not “health” insurance, and show them that paying me and not a faceless entity is the best value for quality care in today’s fractured system.
Hi, Dr. Cox.
Thank you for your thoughtful comment and for joining in on our discussion.
You make an interesting point, and one that I have heard from others as well, that health care insurance should operate more like other insurance, something one does not plan to use and uses only for catastrophic health care issues.
One thing that I did not detect from your comment or from others who have made this observation, is that the other thing that would happen in other forms of insurance is that once you use it, your premiums go up. Have a car accident – your auto insurance rates go up. Have a flood in your home – your flood insurance rates go up. And in some cases, you could become uninsurable. I suspect that you would not suggest that rates go up just because you had to use your health insurance, but I would be interested to know if you think otherwise.
Of course, there is a model similar, but not identical, to what you propose: high deductible health care plans. While I am not an expert on insurance, I believe there are two challenges that this structure creates.
First, until the deductible is met, people may defer needed care or services, and you and I know that many conditions can be treated less expensively if caught early. The deductible is often a significant financial hurdle for most families.
Second, once the deductible is met, there is little disincentive to consume as many services as possible for the remainder of that year.
I do understand that there is a slight difference to what you are suggesting. However, here is my concern. At a time when many people have to or do make decisions between prescriptions and groceries or other needs, and at a time when we are trying to reduce avoidable admissions and readmissions to hospitals, do we want people to have less coverage and perhaps avoid an office visit or taking a prescription that might keep them out of the hospital?
You do raise many valid points, points that need to be addressed in whatever model we go to, but I am not pursuaded that a change in the character of insurance as you and others have suggested would lead to better health, better care, and lower total cost of care. That said, I am keeping an open mind as we all continue the discussion and perhaps I can be persuaded differently.
Thanks for following the blog and thanks for your comment!
Great perspective, Dr. Pate.
The shift in the marketplace toward consumerism in all the health services fields (notice all the dental billboards lately!) reflects changing public needs resulting from the technology explosion and the Internet.
Consumers are more informed than ever. The empowerment of the people is good, and challenging to some service offerings. Mechanics have had to shift their marketing to reach a more informed consumer. Brick-and-mortar stores have changed their retail models to reach a less localized customer. And now, the medical field must look at consumerism as a real target.
Hopefully the competitiveness will increase the quality of the services offered by providers. It sure has benefited consumers in other industries.
Hi, Ron.
Great comment! I think you are right about the shift in the marketplace toward consumerism and believe that we ignore this at our own peril.
I do think that e-health, m-health, and all the things we have been talking about have a great potential to better inform care, better monitor care, and better coordinate care, and therefore will not only respond to the wants of the patient, but also give them a more gratifying experience. I truly believe that once the business model is changed, physicians will like it better, as well.
Thanks for following the blog and sending in your comment!
As a low-income senior patient, I’m finding this entire thread disturbing.
What exactly is a consumer? One who consumes, uses up, takes away from stock or inventory. What does this have to do with health care?
I am not an old-fashioned patient. I like my doctor to discuss with me my symptoms, the path to diagnosis, the need for tests, and the wide range of possible treatments, including doing nothing or “watch and wait.” Then I state my choices, and if my doctor disagrees, she tells me why, and I adjust my choices as needed. If I wonder about the need for a specialist, we discuss that as well.
None of that bears any resemblance to going into a store, looking over the goods, and making a choice. I believe this trend in new language is simply a move by the very large health care industry to turn us into robotic consumers, using more and paying more. Direct-to-the-patient advertising is not about education, it is about marketing and pressuring the physician to prescribe more than (s)he would normally.
I think St. Luke’s made a good decision not to accept samples from drug salespersons. Often the sampled drugs are those that cost more when an older, less expensive medication would work just as well. There is no marketing for older drugs. That should tell us something.
As for online medical information, my son is in global information security. He doesn’t believe we are ready to protect medical privacy in the face of more and better hackers. I love the convenience of the Internet but it IS semi-public by it’s very definition and nature. The concerns must be addressed first.
Kudos for this blog and being open to opinions. Thank you.
Hi, Ms. Fackler.
Thanks so much for joining our discussion. I love getting your perspective as a patient!
I agree totally with you about the direct-to-patient marketing. I also thank you for your appreciation of the stance St. Luke’s has taken with respect to medication samples.
It sounds as though you have a physician that you feel comfortable with, who addresses your needs and provides you with the information you need. That is wonderful.
I would be interested in what you might say to these questions:
1. Would you change physicians if your current physician was not willing to engage in shared decision-making, i.e., your physician had strong opinions about what your treatment should be and what specialists you should see, and expressed those as instructions for your management, rather than discussing all the options and incorporating your preferences?
2. What if you moved somewhere? How would you go about selecting your new physician?
3. Would you be willing to change physicians if you learned of another physician close by with a great reputation, who offered night and weekend hours, and was willing to discuss problems you considered minor over the phone, instead of having to come in for an office visit?
Thank you so much for following my blog and for taking the time to write in. The better we understand the wants and needs of patients, the better job we will do!