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.
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.
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!