- William Gilkison, MD
For decades, health care analysts, policy makers, administrators, and pundits have talked and written about “good quality health care.” But has anyone ever defined just what good care means? Does it mean the patient got well? That the physician met all the quality measures criteria? What defines quality medical care for patients? What is it that gives them reassurance and the knowledge that they are being well-cared for? After all, it’s the patient's definition that really matters.
Now that I’m retired from family medicine, I frequently hear from friends and former patients stories about how their doctor doesn’t seem to listen to them, how they can’t get through on the phone, how he doesn’t return their calls, how she doesn’t get back to them with lab or x-ray results, and how their staff doesn’t seem to care. These perceptions all play a role in how the patient (an anxious human being) defines quality care.
They say first impressions define the situation, so it is imperative that the first contact patients have with the doctor’s office does not result in frustration. The individual who answers the phone sets the tone for the whole encounter. If this person is surly or curt, could the doctor be like that, too? How comforting it is to a patient when the person on the other end of the line recognizes their concern, anxiety, or voice and treats him or her as one would a friend.
Many other seemingly minor issues determine the patient’s perception of good medical care. Was the patient allowed time to relate the history and symptoms? Did the doctor listen, not interrupt, and seem interested? Were appropriate follow-up questions asked? Were all the patient’s concerns addressed and questions answered before he left the exam room?
Anxiety is made worse by fear of the unknown. It drives people nuts to have to wait a week or longer for important, sometimes life-changing results when they’re in pain or worried they may have cancer. Results of blood work, the abdominal CT for that belly pain, the MRI for that headache, or the biopsy of the breast or prostate mass - all of these normal and abnormal test results should be reviewed by the physician as soon as they are available, and a disposition made immediately. Patients appreciate this more than one can imagine.
In my view, then, the definition of good care includes communication, patience, concern, and perseverance. A high quality, "patient-centered" medical home is based on these human characteristics and not on outcome criteria, EHR meaningful use, or other measures. To the patient, good care means this: the doctor saw me when I needed him, diagnosed my problem correctly, treated it appropriately and effectively, gave me my test results without my having to ask, communicated permitted pertinent information to my loved ones, and asked how I was doing the next time we met. And better yet, his office staff knew my name when I came in. Isn’t that just like being at home?