I was talking to a patient a few days ago who was raving about a local grocery store.  "They get it," she said.  "They understand how to take care of their customers." It made me think about how far medicine has drifted away from the same idea.  Ironically, despite the fact that our "customers" (people who pay us for our services) are seeking us so we can "take care of" them, we do a lousy job of taking care of our customers.  It has been an obsession of mine since I started practice, but it has been something that has been increasingly difficult to accomplish.  I now have to fight against the need to meet "meaningful use" criteria so that I can have time to make the record meaningful and useful to my patients.  I have to fight against the need to conform to "medical home," criteria so  that I can make my practice the place my patients see as their ultimate medical haven.  The more the government and insurance industries push me toward focusing on my patients, the less time I have for my patients because of the need to meet criteria proving that I am caring for my patients.

It's a mess.

So I went back to my roots.  What do I really think should be the rights of my patients?  Here is a list that I made:

Patients have the following rights:

  1. The right to have access to care when it's needed
    1. This does not mean the care is done in the office either.  It can be done over the phone or via computer.
    2. The schedule of the office should accommodate the patients' needs as much as is reasonable to expect.
  2. The right to have care that is convenient
    1. They should not have to wait to be seen or wait on the phone to be heard
    2. They should not have to come in for problems that can be handled at home or work
  3. The right to have a doctor who is not motivated to have sick patients
    1. Having a doctor with the same motivation as the patient: to keep the them healthy
    2. Having a doctor who does not only react to problems, but works to prevent them
  4. The right to get care that is not rushed or distracted
    1. Visits are as long as they take to deal with the problem
    2. Phone calls aren't cut short from fear of offering "free medicine"
  5. The right to be treated as the one paying for the service of the doctors and their staff
    1. Patients should be satisfied with the "customer experience" in their doctor's office.  They should feel like they spent their money wisely.
    2. They should never feel like a "number" or that the visit revolves around the doctor.
  6. The right to have care that pays attention to cost and does not overdo care
    1. Good care does not mean overdoing it.  Good care means offering the care that is best.  Sometimes (often) that means doing nothing.
    2. Expensive labs, tests, and drugs should always be considered as to the benefit they offer versus the cost they incur.  
    3. The patient should be able to make an informed decision regarding the care they get, increasing their investment in following-through on things.
  7. The right to have access to all of their records at any time
    1. Online access to records is a must.  The lab tests do not belong to the doctor and doctors shouldn't be afraid of the patients seeing them.
    2. The part of the chart (most of it, actually) which the patient knows more than the doctor should be available to edit and control by the patient.
  8. The right to have a doctor who knows what is going on with them
    1. This means that the PCP should always have accurate information about any other care the patient has received.  Because of the state of our system, this does put some burden on the patient to communicate with the doctor.
    2. This means that all specialists should know why the patient is being sent.
    3. This means that hospitalists should know what's going on outside of the hospital and the PCP should know what's going on in the hospital.
    4. This means the PCP should regularly review patient records to know if care is being missed.
  9. The right to understand their care and not be afraid to ask when they don't
    1. Every visit should end up with a clear plan.
    2. Preventive services should be clearly understood and spelled out as to when they are due.
    3. The patient should have access to the doctor if confusion arises and get a quick answer to any questions.
    4. No care should be given without a good explanation.
  10. The right to be treated with empathy and respect
    1. Medical professionals should understand that it's hard to be sick, to have pain, and to die. 
    2. The interaction between doctor and patient is a human interaction - the interaction between to flawed individuals.  This means an expectation of perfection on either side will only result in bad care.
    3. Patients should never be afraid they are going "to get yelled at" by their doctor.  They should feel free to be open when they don't do the right thing.
The biggest irony is that making this list allows me to meet some of the criteria for "Medical Home," and future criteria for "Meaningful Use."  Great.  Check that off of my list.  The problem is that both of these criteria I am working on meeting have a net negative effect on my patients by making me more busy in checking off tasks and reporting data, giving me less time to actually give my patients these rights.
So what do you think about this list?  How should doctors work toward patient rights in a setting where we are increasingly burdened with criteria to prove we are meeting them?  How can we meet criteria when they themselves are one of the things keeping us from meeting their own goals?
I want to know what my patients want and what they need.  My ultimate goal is to meet those needs like the grocery store is doing, offering such good service that when my patients go to the grocery store they brag to the people there about the good care they get from their doctor.
Imagine that.

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