Quit Wasting My Healthcare

The #1 Thing You Can Do to Impove Healthcare Quality

On this blog I write a lot about how to be more cost-effective in providing and receiving care. So today I am going to focus on QUALITY.

Much is in the TV news, magazines and professional journals about physician and healthcare quality. Usually the story is that quality is BAD… terrrible in fact. I am not going to tell you if your doctor is good or bad, but there is one thing YOU CAN DO to improve the quality of care that YOU receive PERSONALLY that does not require an act of Congress, a complicated health website or an episode of Oprah.

The #1 thing you can do is: TAKE NOTES

Take notes during your doctor visit. Take notes when you are in the ER. Take notes if you are in the hospital. Always have a pen and paper in hand. If because of your medical condition you cannot take notes, have someone else take notes for you.

Studies have shown that patients DO NOT REMEMBER HALF of what their doctor tells them and often they do not understand the other half that they do remember. Doctors and their staff move very fast. Most physicians are always in a rush. Combine this fast pace with complex medical terminology and it is a recipe for miscommunication.

Here is the second thing you can do related to the first:

READ BACK THE NOTES YOU HAVE TAKEN TO THE DOCTOR

You have to confirm that what you heard is actually what he or she meant. When I ask my patients to repeat back what I have just told them… I’ll be honest, the majority of them cannot repeat back to me what they need to do. It’s not their fault. They are not stupid. It is just miscommunication.

Reading back the notes to your doctor will also make him or her s l o w d o w n. The best surgeons I have ever worked with do not rush. The best cardiologist I ever worked with at Johns Hopkins never rushed. Very smart physicians, very ‘high quality’ physicians can make mistakes when they rush. Reading back the notes is a very non-confrontational way for you to make your physician slow down and this will increase the quality of the communication.

Let me give you an example for a person with diabetes. A very common list of instructions for this diabetic person at the end of their visit goes like this, “Your diabetes is not very well controlled. Your hemoglobin A1c is 9 and it should be less than 7. I want you to take your metformin twice a day instead of once. Your blood pressure is too high as well. Your blood pressure today was 156/90 and it should be less than 130/80. I want you to start taking a new blood pressure medication called HCTZ in addition to your Lisinopril. Then I want you to come back to the office in two weeks for a blood pressure check with the nurse and get some more blood work done to make sure your kidneys are ok, because you have had some kidney problems in the past. Also, you are due to get your eyes checked by the ophthamologist, so you need to make an appointment for that as well.”

That is a lot of information. Every bit in there is a “diabetes quality measure.” It is an unreasonable expectation to think that a person is going to remember all that. Write all that down and say it back to the doctor and I guarantee you will find miscommunication.

“Why is my hemoglobin A1c 9? When I check my blood sugar it is around 200. Why are the numbers so different?” — “Well, they are on a different scale. The hemoglobin A1c is a test we use to see how you have been on average over the last 3 months.”

“What’s metformin? I take glucophage.” — “Well it’s the same thing.”

“156/90?! Oh, that’s pretty good. Usually when I check it at home it is 180/90.” — “Oh, that is way too high. We’ve checked your home BP cuff and it is pretty close to the one here. Why didn’t you tell me that before? I am going to increase the dose of your lisinopril as well to 30 mg once daily. Here is a new prescription.”

“I’m suppose to go away on vacation in 2 weeks. I’ll be gone for 5 days. Can I just wait until after my vacation to come in?” — “Why don’t you come in at least 2 days before your trip to make sure everything is ok.”

“I just went to the eye doctor last month. Do I need to go again?” — “I had no idea you went to the eye doctor. I’ll have to get in touch with Dr. Lenz to see if you had any retinopathy.”

TAKE NOTES. READ THEM BACK TO YOUR DOCTOR. You will improve the quality of your communication and you will improve the quality of your care.