All too often we forget as healthcare professionals about the consumers and their thoughts about our healthcare system. This series is to communicate what consumers are thinking in various areas. Ultimately, it will be our relationship with them that makes us successful or not. Are you talking with your consumers (patients)? Even more, are you involving consumers in your process improvement programs? Let us take this month to dive into the world of the consumer and healthcare. Trying to understand their point of view is incredibly important because only then can we begin to understand and make positive changes that impact the consumers in healthcare.

HealthBond’s series of articles about consumers and healthcare will provide some of the answers and some useful resources for the information-age consumer and the healthcare provider alike. In this series of articles, we will explore topics such as:

• the consumer's view of the system;


• consumer thoughts about physicians, hospitals, and how from their perspective relationships/communication could be improved;


• consumer thoughts about payers;


• what consumers think about government-sponsored health insurance and how it could be improved;


• what the future looks like for consumers and healthcare: Who will be the drivers?

Since the mid-1970s, consumers have been increasingly empowered by various watchdog and media groups. However, the paternalistic attitude of "we know best" continued in healthcare industries until almost the present day. In fact, many of the communication problems that exist between consumers (patients) and providers (doctors and hospitals) can be directly linked to that attitude. In the past, it wasn’t considered correct to question your doctor’s diagnosis or prescription advice; today, people routinely do their own research on their illnesses, and ask doctors about what they find. This occasionally creates friction in the doctor-patient relationship, but overall the trend is moving toward better communication.

‘Often a patient and his family hesitate to ask if a second opinion would be beneficial,’ Dr. Groopman writes, ‘because they fear they will ‘insult’ the doctor, that the question will be misconstrued as a threat and alienate their caregiver.’(1).

Does the trend of doctors spending less and less time with each patient have a negative impact? Studies are still being done, but common sense tells us that if doctors don’t have time enough to listen to each patient, eventually important diagnostic clues are going to be missed, and the outcome will be a poor one for the consumer (patient). That, and doctor burn-out will negatively impact the healthcare industry as a whole. Patients are not beans to be counted. They’re people and so are the doctors and other healthcare providers trying to help them. Quality of care has to be a priority topic for consumers and healthcare providers.

The pressure to see 50 or so patients in a day and to spend six or so minutes with each one is not enough time to say hello. ‘This ill-guided emphasis on doing things quickly, rather than well, has certainly accentuated the problem of error,’ Dr. Ludmerer said. ‘You just make too many mistakes if you’re doing things quickly and have to cut corners.’ (2).

Consumers have the power of law behind them now to a much greater extent that before, with the Consumer Bill of Medical Rights being debated currently in Congress. They have the ability to choose their own health programs and insurance groups while at work, and that trend is also broadening. Employers are looking at allowing their workers to buy their own insurance rather than the company providing it, using a system of vouchers or payments to the employees to cover the costs. At any given medium to large company today, employees can choose from usually three to four different healthcare insurance programs. Companies have figured out that they need to help their workers pick programs, and provide training sessions and guidance to do so as part of the process.

"A growing number of companies are adding specialized services… to help their employees navigate through the mass of medical information available today…companies believe that their employees will get better care and that they may be less inclined to proceed with treatments deemed not appropriate. Employers hope to save money at a time when health costs are rising 9 percent or more a year. In the longer run, many employers that offer the added advice are also trying to prepare their employees for a shift the companies hope to make toward a system of vouchers for medical care. (3).

However, the consumer attitude toward HMOs is steadily shifting towards the negative end of the spectrum. More and more consumers are questioning why their doctors are only allowed eight to twelve minutes per patient by HMO rules, and why certain drugs are not covered by the HMO plan they have chosen. Doctors are joining the consumers in this case, complaining about the little time they are allowed to spend with each patient and how that affects patient outcomes and service. Consumers are making this problem well-known to their Congressional representatives as well as to healthcare industry leaders, and change is in the wind. The question is, where will we go from here?

‘Employees are suspicious and mistrustful of managed care and the health insurance industry,’ said Larry Gelb, president of CareCounsel… The managed care industry is well aware of such problems. A number of HMO’s are now adding programs to help consumers understand their choices, said Susan Pisano, a spokeswoman for the American Association of Health Plans, a managed care trade group. ‘We want to put the consumer at the center of the system and empower her with information and access,’ said Dr. David Lawrence, chief executive of Kaiser Permanente, the California-based nonprofit HMO.(4).

Will consumers become even more part of the process in finding solutions to the healthcare crisis in America? Or will they be shunted off to one side, the paternalistic attitude from earlier times winning out in the end? How much say-so will the modern-day healthcare consumer have about the future of medical care in the United States? Who will drive the changes, the industry or the consumers? Where do the opinions and experience of healthcare providers come in? Is it all one thing (industry-driven, for example) or can a team approach work? All this remains to be seen, but certain trends are becoming clear. One of the main trends standing out above the others is that consumers, once empowered, resist being shuffled off to the side. Healthcare consumers enjoy the ability to ask questions and seek solutions, and the healthcare industry as a whole is waking up to that fact.

The role of the Internet in consumer awareness of healthcare information and resources cannot be understated. More and more people are turning to the information superhighway as a resource, finding answers for their medical questions. However, all may not be as it seems on the Internet, and doctors caution that all information is not the same quality. Some sites are less than scrupulous about what they post, and less than accurate in their informative value. Doctors and other healthcare providers tell stories of patients coming in to their offices with hundreds of questions, pages of information printed from various sites… Information gathering is good, a coping measure; what happens when the information is not accurate or frightening to the patient? There is no rule of law as to what content the Internet has; anyone can put just about anything on there, and consumers have to employ that rare commodity, common sense, to sift through the coal, looking for a diamond. How can we, as healthcare professionals, assist in that information gathering process? Various resources do exist, however, for the savvy consumer, and we’ll provide a list of reliable medical information sources in an article coming up in the next couple of weeks.

What do Jane and John Doe, consumer, think about all these issues? What are you doing, as a healthcare professional, that makes a difference in this area? How do you deal with your patients effectively and efficiently? Is there a way to do both? As consumers and as healthcare providers, we have to realize what we think really does count. Make yourself heard.