EPtalk by Dr. Jayne 6/2/22

Surprise, surprise: research shows that patients understand their health records better when they are not full of abbreviations. The study, published in JAMA Network Open, showed improved comprehension when certain abbreviations and acronyms were spelled out. Although study subjects had previous exposure to healthcare organizations, their initial understanding of some common abbreviations was below 40%. Looking at a set of 10 common abbreviations, expanding them increased comprehension from 62% to 95%. The authors urge clinicians to consider that patients may not understand abbreviations and medical terminology. Abbreviations aside, it’s important to understand the low level of health literacy across the US and the need for most patient-facing communications to be written at or below the sixth-grade level.

I recently had another trip into the Patient Zone, and even as a healthcare provider, I found some of the things I encountered confusing. I know how to navigate the system and I still have a post-visit issue that remains unresolved three days later. The office was running significantly late, so I got to listen to quite a few inappropriately overheard conversations. One involved a staffer who kept confusing two “sound-alike” medications to the point where I wanted to step out to the clinical station and correct her. Losartan is for blood pressure, Loestrin is an oral contraceptive. I later found out that she wasn’t working in her usual clinical location because they had floated people to the office to cover shortages. Still, I hope that no one was harmed on their watch. I received some wonky directions from people in the office and it makes more sense if they were temporary staff, but the average patient might not know to question it.

I’m also trying to put myself in the shoes of patients who are receiving immediate lab results via their patient portal accounts. The clinician I saw warned me, “you’ll probably see your results before I will” and she wasn’t kidding. Barely six hours after I left the office, I started receiving a flurry of “new result available” alerts. I’m not sure how the labs were ordered, but each component of the blood work was coming back as an individual result with its own notification. It was unnerving to say the least, especially since the ones I was really waiting for weren’t among the first to return. As a physician, I know what the results mean, but as a patient I can imagine it might be very frustrating. My guess is it won’t be until sometime next week before I receive an official interpretation, once all the results have returned. I’ll be interested to see how the rest of the process goes, and if my pharmacy benefit manager will ever sort out the erroneous script that was sent. I tried to resolve it, but they were never able to find the provider’s name in their system (despite me being able to see the erroneous script from the patient-side login) so I’m betting at some point I wind up driving to the office to pick up a paper script and fax it in myself.

Needless to say, there’s a long way to go for some healthcare organizations to really embrace the idea of patient-centered design. There have been a lot of healthcare futurists over the last decade who have said that patients will vote with their feet and drive their healthcare dollars towards organizations that deliver care that is personalized and consumer friendly. Pre-pandemic I still saw the majority of patients choosing their care based on insurance coverage with very little consideration of quality metrics or anything else. Now, with all the staffing shortages and physicians leaving patient care in droves, patients seem to just be getting in wherever they can. In my area, one of the largest health systems has over 4,000 patients on its wait list for a particular specialty, which now refuses to accept any referrals from outside the health system. That doesn’t seem terribly patient-centric to me. The organization blames its inability to recruit for the shortage of clinicians. I guarantee that if they raised their salaries above 25th percentile they’d be able to recruit.

After reflecting on these recent experiences, I wasn’t sure I was in the right frame of mind to read yet another article about a “man on a mission” in healthcare. One of my shoe-loving friends has a huge crush on Glen Tullman though, so I figured I better keep up so she and I have something to chat about. The premise of Tullman’s latest venture, Transcarent, is leveling the playing field for patients as they try to meet their healthcare needs. He calls out the fact that the health insurance industry is one that doesn’t operate in the best interests of its customers. The article calls out the fact that when insurance companies profit, each dollar represents care that patients didn’t receive. Tullman proposes giving those dollars back to large, self-insured employers who are footing the bill for coverage.

It will be interesting to see if Transcarent is able to succeed where other companies have failed. Haven tried to do this a few years ago for employees of Amazon, Berkshire Hathaway, and JPMorgan Chase. So far, more than 100 companies have signed up, eager to see savings on their healthcare spending. Transcarent makes its money by taking a cut of that savings, which is achieved through pre-negotiated pricing for services as well as by directing patients to lower-cost alternatives. Corporate customers are gravitating to the approach as are health systems, some of which are financially backing the endeavor. Walmart is jumping in with a recent agreement to become a preferred provider, offering primary care, mental health, and dental services. The article was enough to hook me, so I’ll be following along as the company expands. They’ve already hired some really smart people, and I’m eager to see if they’ll be able to move the needle.

Happy 19th Birthday HIStalk! I didn’t have time to do proper pastry therapy, so this option from my neighborhood Costco will have to do. Even though white cake is my favorite, you really can’t go wrong with a cake that is filled with their signature mousse.

What’s your favorite birthday pastry? Leave a comment or email me.

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