Patient Experience: A Critique
I recently took a relative for a routine medical procedure and realized just how far we are from an ideal patient experience and the dreamy state of optimal population health.
I escorted a beloved relative to what was a simple, ten-minute outpatient procedure, a genicular nerve ablation, at a pain clinic. Presumably, this wasn't their first rodeo, though it was her first such procedure. Yet it might as well have been their first. I won't go into everything that went awry during our visit, but here’s a quick summary of her patient experience.
How much will this cost?
No one could tell us how much the procedure would cost. While this pain clinic [allegedly?] does several of these procedures each and every day, no one was able to tell us how much Medicare would or would not pay, or whether we could expect a bill from either the independent physician (who only worked at the facility) or the hospital (which actually owned the pain clinic), or even whether or not the procedure was definitely covered. Perhaps she was their first ever Medicare patient, but I doubt it. In what other industry would a service or procedure be conducted without at least an estimate of cost being provided?
So much for listening to the patient!
One of the nurses (there were several, at least five, who “touched” her case today) asked my 87-year old relative, “Do you think you’ll want some anesthesia for this?” Now, given that this was her first such procedure, she obviously didn’t know how to respond. “Is it for pain or anxiety?” I asked. “Kinda both”, she replied. I asked my relative if she was nervous, anxious, or worried about the pain of the procedure, and she said no. So, the answer from the patient was, “No, I don’t think so…I’ll be just fine”. Of course, the nurse didn’t like that answer, so she said, “Well, he [the physician] may want you to have some, so we’ll give you some just in case”. So much for listening to those crazy old patients! What do they know?!?! How’s that for providing an exceptional patient experience?
Well, it just depends…
As we all know, setting post-procedure expectations can be one of the most important factors in creating an exceptional patient experience and contributes a great deal to a patient’s satisfaction with their care. If the patient knows what to expect (e.g., less pain, better mobility, swelling, nausea, etc.), their likelihood of satisfaction from a successful procedure is logically better. Expectations drive satisfaction – which, in turn, results in a positive patient experience. This is especially true of pain in this case, since the purpose of the procedure is dramatic pain relief.
Yet, despite the number of these procedures done each day in this pain clinic, we received four very different answers to the simple question: “When might actual pain relief be felt?”
- The brochure from the pre-procedure appointment four days ago stated “one to two weeks” (as does most of the literature I could find on the subject). However, the pamphlet (published by the same vendor) given to us on the day of the procedure claimed “immediate” relief, as did the first nurse who saw us.
- The physician was less optimistic, predicting three to four days, which was of course better than one to two weeks.
- But the second nurse was more on board with the “one to two weeks” estimate, until I noted the comments of the first nurse. She checked the trusty brochure and was shocked to see that it had changed from the “old” estimate we received only four days prior. “Well, they must have run out of those pamphlets”, as if the availability of a particular vendor brochure dictated clinical outcomes.
- Finally, a third nurse (who would accompany my relative into the procedure) gave the ultimate answer: “Well, it just depends.”
We've got a long way to go…
Folks, forget big data, forget ACOs, forget new payment models for quality outcomes for just a moment. Can we first just determine a reasonable and consistent answer to the question, “How long is my knee going to hurt after this procedure is over?” If we can’t create a patient experience that provides patients with answers to simple questions, I’m not sure we’ll be able to do the rest.