Sunday, March 17, 2013

Aren't Doctors Responsible for Patient Care and the Medical System?

Doctor patient relationships are a timely and important topic in America. For the fact is, medical training and education aren't guarantees of perfection in patient care. And it's time for doctors to take ultimate responsibility for the system.

Doctors have a tendency by virtue of education and authority to issue medical commands and assume they're done. But the command mentality doesn't work in profitable businesses (it may exist only in the legal and judicial systems, but that's a topic for another post).

And doctors must put patients first. It's not wise to put profits ahead of basic patient care. And medical care is different from business; it's like education in putting the needs of students first. But whether for profit or not, doctors need to learn to assess patient care. Because in present-day healthcare, patients go to doctors trusting they'll get competent care, but rely on nurses and office staff to deliver a large percentage.

An essential business issue is that businesses fail. Unless a restaurant's in a location where clients don't have any choice, the restaurant can fail. Or fashion designers can fail if they create clothes that fashionistas won't buy.

And yet doctors can be gruff, patient-unfriendly, and untrustworthy, and get away with it, simply by being in a certain location and invoking and marketing the fact they've been professionally trained and licensed, and so must, ipso facto, be delivering adequate patient care.

But doctors should know they won't be great doctors unless they give great service. And doctors don't even give adequate service if they simply issue commands. Doctors are trusted to do their work if they find out whether their advice has been carried out, and so they must care about patient experience. And they should follow-up better with patients.

Follow-up doesn't happen efficiently in a system where pay-per-visit insurance rules, tests are paid out of pocket in some cases, and where loyalty is uncommon as it is in America. And why should a patient be loyal if the doctor changes insurance plans, moves suddenly, and disappears after signing non-compete clauses. Doctors are also guilty of prescribing dangerous and expensive tests unnecessarily, and not advising patients of results by following through and reminding patients of another appointment. And doctors works in a system that doesn't reward loyalty and least expensive care. 

But isn't the patient the most crucial element of this doctor-nurse-patient triad? Because without the patient, doctors and nurses aren't necessary.

For the doctor who sits as a client at a restaurant and eats a meal is the most crucial element to the restaurant. The restaurant needs clients to profit and continue to exist, and the owner has responsibility for the client's experience. Or if the doctor can't find a sweater in a clothing store, the doctor knows the store is responsible for not providing it.

And what happens to a doctor's patient is the patient internalizes personal needs and complaints, and experiences firsthand the failings of doctors and the entire medical system. But if patient needs aren't met, who exactly is at fault, the doctor or the system?

Obviously, doctors have to become more patient-centered, and care more about the patient. Instead of assuming all will be done according to command, doctors need to be more sensitive and vigilant about patient care. Because doctors have ultimate responsibility. And what they want probably isn't done as they expect and hasn't ever been.

The challenge is: it's time to be responsible, to change and improve patient care. And if the system has to be changed to improve patient outcomes, then it has to be done. Why? Because doctors head the medical system and bear ultimate responsibility for the quality of patient care. And because patients assume doctors have command of the system, and patients would like to be able to trust their doctors in all ways. Doctors simply must take command of their system in any country.

For further reading, an excellent article in The New York Times called "Healing the Hospital Hierarchy" (Mar. 16, 2013) discusses the doctor-nurse hierarchy, and how these relationships in hospitals sometimes break down. Doctors blame nurses, and nurses must either follow doctor's orders, or be terminated.

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