Patients used to accept doctors’ orders without question. Today, more are asking questions and challenging their doctors’ opinions. However, even those who do it politely are likely to be labeled “difficult.” A doctor whose late wife nearly made a career of being a difficult patient discusses how patients can do it respectfully and fruitfully.
Dr. William Steinbach, Professor, Chief of Pediatrics & Infectious Diseases, Duke University
In some areas, it has become almost impossible to find independent physician practices. Many of these smaller practices have opted into being bought by hospitals and other large medical groups. So, what has prompted the increase of consolidation in the medical field? And what does this mean for patients?
The incentives of consolidation have been researched, but the results do not point to one reason. Dr. Laurence Baker, Professor of Health Research and Policy at Stanford University School of Medicine, explains that physicians running smaller practices might benefit from no longer having their own business. Another possibility, Dr. Christopher Ody, Research Assistant Professor at Kellogg School of Management at Northwestern University, explains, is that some hospitals may view consolidation as a way to improve the quality of healthcare and decrease the costs to help physicians and their patients. However, data has indicated that the factor with the largest role in consolidation has to do with increasing the amount that hospitals are getting paid, and decreasing the amount paid to pharmaceutical companies. Even though research has not provided an overarching incentive that drives consolidation, the data seems to point to increasing income for hospitals rather than providing patients with better care. Furthermore, hospital consolidation has not been shown to benefit the patient. Dr. Baker explains that data indicates that the cost of healthcare has not gone down for patients with consolidation. Since the cost of healthcare has increased for patients, many have started to wonder how consolidation has been able to continue and what is being done to control it.
In the medical field, it is important to maintain consistency in market concentration and ensure that the markets are still competitive. One way in which authorities in the medical field work to maintain market concentration is by regulating transactions that reach a price threshold. However, Dr. Ody explains that hospitals have been able to avoid these regulations by partaking in multiple smaller transactions that invest in a small number of physicians at a time in order to ensure that the cost is below the threshold for evaluation. By avoiding regulations, hospitals have been able to grow into much larger entities that generate a lot of power and income from smaller practices. Since consolidation has prompted increased healthcare costs, it currently appears to be detrimental to the medical field rather than helpful. Yet, it could be worth it if hospitals were able to determine a method of consolidation that decreases healthcare costs and improves the quality of care that is provided to patients.
Dr. Laurence Baker, Professor of Health Research and Policy at Stanford University School of Medicine
Dr. Christopher Ody, Research Assistant Professor at Kellogg School of Management, Northwestern University
We all know that doctors endure years and years of schooling and training in order to learn how to diagnose their patients and provide them with the best care. But, studies have shown that many doctors tend to miss details about other aspects of a patient’s life that can also have an affect on their wellbeing. Dr. Saul Jeremy Weiner, Professor of Medicine, Pediatrics & Medical Education at University of Illinois and co-author of Listening For What Matters: Avoiding Contextual Errors in Health Care, explains that patients will make important comments that do not necessarily pertain to their symptoms, but that this information is often overlooked despite being critical for a doctor to understand in order to provide the patient with an effective care plan. But, what is the overall impact of this on the patient? Dr. Weiner and Dr. Alan Schwartz, Michael Reese Endowed Professor of Medical Education at University of Illinois, Chicago, and co-author, Listening For What Matters: Avoiding Contextual Errors in Health Care, have done their own research that has shown the effects of doctor’s that are too focused on the biomedical details in providing care for patients. Dr. Schwartz explains that the results of their research showed that doctors who address the patient’s personal life were able to provide a much more successful care plan for the patient. Furthermore, the study also showed that the cost of healthcare for the patient increased when the doctor was too concerned with the science of the diagnosis. In order to have the most successful outcome without increasing the cost of healthcare, doctors must address more than just the patient’s biomedical symptoms.
So, how can doctors learn to listen to their patients more efficiently? Dr. Weiner suggests using an approach commonly used in other industries: mystery shoppers. In the medical field, a mystery shopper is an unannounced standardized patient that is trained to go into a physician’s office and provide data to help identify problems–a tool that many doctors have found to be helpful in improving their practice. Dr. Schwartz states that by investing in improving contextual care doctor’s will be able to provide better care for their patients and decrease the cost of healthcare, too. However, all patients and employees in the medical field must be willing to undertake these methods and procedures in regular practice in order to improve the overall experience for everybody.
Dr. Saul Jeremy Weiner, Professor of Medicine, Pediatrics & Medical Education at University of Illinois and co-author of Listening For What Matters: Avoiding Contextual Errors in Health Care
Dr. Alan Schwartz, Michael Reese Endowed Professor of Medical Education at University of Illinois, Chicago, and co-author of Listening For What Matters: Avoiding Contextual Errors in Health Care.
Almost every portrayal of doctors depicts them to be unequivocally good, and many people believe this portrayal. However, this belief has been under scrutiny recently. In light of the recent case against Dr. Larry Nasser, physicians and patients have started to focus their attention on doctors who sexually abuse patients and investigate the outcomes of these crimes, and the results are nothing short of disheartening.
Danny Robbins, an investigative reporter for Atlanta Journal-Constitution, has spent a lot of time examining the official response to this problem of doctor’s who sexually abuse their patients. He found that more than 2,400 doctors have been sanctioned by medical boards for sexual abuse of their patients, but more than half of these doctor’s still had their medical licenses. Among the doctors who did have their license taken away, Robbins discovered that many were able to easily get them back and continue practicing. The reasoning behind this is similar to a reasoning found in the criminal justice system: people working in these fields do not want to report each others misbehaviors. Robbins explains that oftentimes medical boards will shield these crimes from the public by not reporting them to the criminal justice system unless the victim reports it. But, even in the event of a victim reporting the abuse, the attorney general is left to negotiate with the doctor’s lawyer, and the medical boards follow the negotiation agreed upon by the doctor and the attorney general. Despite the number of doctors that are reported for sexually abusing their patients, few of them face punishments, and among those that do, the punishments are not severe and leave the abuse unknown to the public.
With little being done to deter doctor’s from misbehaviors, what can patients do to protect themselves? Dr. Altaf Saadi, neurologist and former sexual assault crisis line worker, explains that patients are always given the option to have a nurse present in the exam room. Along with this, Robbins also states that patients can go online and see if their doctor has been sanctioned at all. However, these records are often left vague, and one might have to do a little more research in order to determine what the violation was. However, Dr. Saadi believes that physicians also have a role in changing this. She explains that physicians should work to counter the environment that allows for these crimes to go unheard. Furthermore, it is important to address the medical boards that allow these doctors to get away with sexually abusive behaviors. Robbins states that the medical boards need to consist of a more diverse group of members who are not all doctors because many boards have few consumer members, if any at all. In order to see a change in the ways that these cases are handled, both physicians and patients have important roles in changing the ways in which medical boards and the criminal justice system pursue these offenses in the future.
Dr. Altaf Saadi, neurologist and former sexual assault crisis line worker
Danny Robbins, investigative reporter for Atlanta Journal-Constitution
Synopsis: TV doctors wield tremendous influence with patients, sometimes even more than a person’s own doctor. Yet studies show that the advice you hear on TV is often unsupported by medical research. Experts discuss how celebrity doctors miss the mark and why they’re so popular.
Host: Nancy Benson. Guests: Dr. Christina Korownyk, Associate Professor of Family Medicine, University of Alberta; Dr. Georgianna Donadio, Program Director, National Institute of Whole Health; Dr. Lindsey Meredith, Professor of Marketing, Beedie School of Business, Simon Fraser University
Synopsis: Bell’s palsy is a frightening malfunction in the nerve controlling half of the face that occurs for unknown reasons. Sufferers often think they’re having a stroke. While Bell’s palsy often resolves on its own, it can leave permanent effects. Experts and two people who’ve had the disorder discuss.
Host: Reed Pence. Guests: Mandy, Bell’s palsy patient; Dr. Steven Lewis, Professor and Associate Chairman, Department of Neurological Sciences, Rush University Medical Center; Dr. Lisa Ishii, Associate Professor of Otolaryngology-Head and Neck Surgery, Johns Hopkins University School of Medicine; Kerry Schrambeck, Bell’s palsy patient
Synopsis: Many doctors believe emotion is detrimental to medical practice, and many patients think doctors are cold and emotionless. But one influential physician explains why emotion is important to doctors.
Host: Lynn Holley. Guest: Dr. Danielle Ofri, Associate Professor of Medicine, New York University School of Medicine and author, What Doctors Feel: How Emotions Affect the Practice of Medicine