Monday, June 04, 2012

After the rankings, what happens in the doctor’s office?

There was a lot of coverage last week when Consumer Reports joined up with the Massachusetts Health Quality Partners to provide public rankings of primary care practices in the state. At GoLocal Worcester, for example, you were able to read a report about Central Massachusetts practices and see how they stacked up against one another.  The survey came out of a MHQP pilot project funded by the Robert Wood Johnson Foundation to provide consumers with valid, reliable, and useful health information.  MHQP is a coalition of consumers, government agencies, hospitals, insurers, physicians, and researchers with a strong interest in improving the delivery of care to residents of the state.

While the comparative aspects of the report are of great interest, there is another aspect of the Consumer Reports article that deserves equal reading.  It is the section that tells you what you can do to improve the experience with your doctor, regardless of which physician practice you have chosen.  Let’s go through the main points:

What you can do to help make sure that your doctor explains things in a way that is easy to understand: 
Take detailed notes. Repeat your doctor’s instructions back in your own words to check that you got them right. If you’re confused, say so. Finally, consider bringing along a friend or relative.

What you can do to do to help make sure your doctor listens carefully to you: 

Ask your doctors to repeat what you’ve told them, to make sure they hear you. If you still have concerns when you get home, ask for a follow-up appointment, on the phone even, and perhaps with a nurse practitioner or physician’s assistant who can spend more time with you. If you would like your doctor to make more eye contact, or sit when he or she talks with you, say so. 

What you can do to help make sure your doctor shows respect for what you have to say: 

A doctor might focus on the benefits of a particular treatment, while you might be more concerned about the side effects or alternatives. Tell your doctor what’s important to you. If you don’t think your feelings are being respected or taken into consideration, speak up. “Say, ‘I don’t think you’re hearing what I’m saying.’” 

What you can do to help make sure your doctor spends enough time with you: 

To maximize your time, prepare a list of questions and concerns in advance, listing the most important first. Ask if there are other health providers on staff who can help you with the less pressing questions. If you want to raise a new health concern during your visit, mention that to the office staff when you make the appointment so they can schedule enough time. 

What you can do to help make sure that your doctor is informed and up-to-date about the care you received from specialists? 

Make sure your doctor knows about the care you get from other providers, including other physicians as well as acupuncturists, chiropractors, herbalists, and other alternative health-care practitioners. Explain why you saw them, what happened during the visit, and what treatments or drugs were prescribed. Make sure those providers communicate with your primary-care doctor, too.  Ask for copies of letters or reports that the specialist plans to send to your primary-care provider. 

How to help make sure someone from the office follows up a blood test, X-ray, or other tests and gives you the results? 

Your doctor should tell you when to expect test results and who will give them to you—and then deliver them as expected, even if they’re normal. Ask for a written copy for your files, too, and see if the practice uses a secure online health portal that gives you access to test results and other information. 

How to help make sure your doctor’s office reminds you to get recommended preventive care, such as the flu shot, cancer screening tests, or an eye exam? 

Ask your doctor about the preventive screenings, tests, and vaccines that are appropriate for someone of your age and health.  If tests have been ordered for you, ask why the screening tests being recommended are needed. 

There is also a similar advice for your child’s relationship with his or her pediatrician.  I urge you to review it. 

Congratulations to MHQP for joining up with Consumer Reports.  While MHQP has been known for excellent data analysis and public policy support, this partnership with an organization well practiced in providing assistance to consumers was huge step in trying to get their information to patients and the public in a more effective way.  As noted by Barbra Rabson, CEO of MHQP, “This is a work in progress as we move closer to giving patients what they demand and deserve in terms of credible health care information, and what is needed to improve our system overall. 

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