Home » Dr. Jayne » Currently Reading:

Curbside Consult with Dr. Jayne 9/30/13

September 30, 2013 Dr. Jayne 2 Comments

Being an anonymous blogger can be very isolating, which is why I think I enjoy following other anonymous bloggers. One of my favorite, Skeptical Scalpel, recently penned a satire about a website where clinicians could rate their patients. Most of my colleagues are less than thrilled about websites where patients can rate physicians. Some have faced negative reviews for patient outcomes that were beyond the physician’s control. Others have been criticized for inability to meet unrealistic patient expectations.

Although it will never happen, the idea of being able to rate our patients is an interesting one. I’m not talking about gathering data for cherry-picking the healthiest patients or dropping those that are the sickest. I’m talking about using data based on previous patient-physician experiences that could better inform how we care for patients. As a PCP, I would occasionally have patients come to my practice because they had been fired from a previous physician for missing appointments. I didn’t have enough staffing or funding to do close follow up on all my patients, but I could immediately assign this patient to a variety of reminders and services to make sure he or she makes it to scheduled appointments as soon as he or she joins the practice rather than waiting for enough missed appointments to see a pattern.

The proponents of patient engagement don’t talk a lot about this, but patients are sometimes inaccurate about their histories and behaviors. It’s simple human nature – we all want to be doing a better job with our health than we might actually be doing, which often leads people to under-report their alcohol consumption or over-report their exercise behaviors.

There are a fair number of diligent and dedicated patients that are as honest as they need to be. Their ranks may grow as records become more transparent and more portable. I don’t know any patient though who comes in and says, “I miss one out of every three appointments I schedule.” That kind of data isn’t anything that mainstream practices are currently sharing with HIEs or CCD exchange.

These non-medical health factors are a huge deal when you’re trying to function as a patient-centered medical home or accountable care organization. Often there is not a good way to figure it out unless the previous caregivers documented that level of detail in the chart. Sometimes when records are transferred, those items are specifically left out because they may fall under behavioral health, which in many states requires a special authorization for release. Rarely does the patient volunteer those details during the initial visit.

I’m a big fan of patients bringing in their data, but only if it’s honest and valid. Technology is a great help with this. Having a patient bring in an exercise log from Garmin Connect is pretty solid because unless they’re strapping the GPS unit to their dog and letting it run the neighborhood, it’s not easy to fake. On the other hand, when patients bring in their handwritten log that shows they’ve walked 60 minutes a day every day for the month and have been compliant with their diet yet have gained 10 pounds for no medically explainable reason, it’s likely that the fudge factor was involved in logging the data.

As an added bonus, being able to rate patients would also provide an opportunity for something that is becoming more and more lacking – physician engagement. I am working with an increasing number of physicians who are burned out, apathetic, and considering other careers. Many practices can’t afford to have health coaches and care coordinators. It’s a Catch-22 where you have to provide the care to get the incentives, but you can’t afford to provide the care without having the incentive payments. Because of that, many physicians take on the work themselves.

You can easily run the return on investment numbers and show them that if they could see two more patients a day (which they could easily do if they delegated more work) they could afford another staffer. Most independent physicians aren’t willing to take the interim pay cut while a new staffer gets up to speed and they can get to the point where they can add those two visits a day. Employed physicians are often locked in to arbitrary staffing numbers their health system forces them to meet regardless of case mix or panel size.

For even the most burned out and disgruntled among us though, I bet I could get them to participate in a patient rating site. If not a patient rating site, there could be other ways of actually gathering objective data about real vs. reported patient behaviors. What do you think? Email me.


E-mail Dr. Jayne.

View/Print Text Only View/Print Text Only

HIStalk Featured Sponsors


Currently there are "2 comments" on this Article:

  1. Dr. J,
    You make some very good points about people keeping track of medical events.
    Another thing I noticed in regards to keeping track of your personal health experiences (at least for me) is if my doc asks how painful was the episode (say you pull a muscle, or have an internal gastric event) the longer the time between the pain and the doc visit the ‘better’ it gets. Like two weeks later I tend to put the pain out of my mind (forgetting has its benefits). If you asked me the day of the event it’s a 9, but a week later I may say 6 or 7, a month later …its was no big deal!.
    It’s probably just the oposite for other folks…you try to be ‘honest’ but your mind can play tricks on you.

  2. Dr. Jayne, you say that “As a PCP, I would occasionally have patients come to my practice because they had been fired from a previous physician for missing appointments”…yet, “rarely does the patient volunteer those details during the initial visit.” So I can’t help but wonder how you know this? Nevertheless, perhaps you could consider adding to your practice workflow having you or a staff member ask the patient if and how they would prefer their appointment reminders. I don’t at all support any patient who is so disrespectful of you and your staff to disregard your time for a scheduled appointment, but sometimes the most obvious approach might work. I don’t know, but maybe just ask?

Subscribe to Updates



Text Ads

Report News and Rumors

No title

Anonymous online form
Rumor line: 801.HIT.NEWS



Founding Sponsors


Platinum Sponsors























































Gold Sponsors
















Reader Comments

  • Mr. HIStalk: I'm torn between wanting to make them stop by showing how ridiculous they are vs. shaming them by name publicly. Apparen...
  • Mr. HIStalk: My personal dilemma is that I don't want to assume that someone attractive who is working a booth must be a contractor h...
  • Ex Epic: My favorite is when you're appropriately washing your hands for the twenty + seconds with soap and somebody is standing ...
  • Evelyn Reed: Thanks for the detailed guide in the conference and other news as well. After months of public negotiating drama and sev...
  • MATTHEW HOLT: I’m getting very bored of the calling out of anonymous social media types. I’m deep enough into the genre to see you...
  • Craig Katz: Just curious - are booth babes gone? If so, when did they go? And was it complaints or companies realizing how much it m...
  • ratherbefishing: I went to HIMSS a lot of years. Other than the social aspect of it I don't miss it. I find it immensely more enjoyable t...
  • You gotta be kidding me: the Sperm bank story made me laugh. "Withholding the remaining sperm" sounds like a vindictive date to me. Do what I say...
  • Donald Lyons: This is probably the better of the HISTALK suggestions: "HIMSS is a show about selling, not doing, and while the form...
  • Lazlo Hollyfeld: It is just a form of self-promotion and attention grabbing that is legion at HIMSS. If you can name one objective an...

RSS Industry Events

  • An error has occurred, which probably means the feed is down. Try again later.

Sponsor Quick Links