New American Patients Putting Physicians Under the Microscope

May 18, 2011

It used to be that you examined the patient. But from your credentials to your use of technology, patients are increasingly examining you. Here's how to deal with this new generation of engaged, informed, and demanding patients.

Patients these days are a demanding lot. They insist on the latest procedures, they expect more bang for their buck, and they'll gladly jump ship for a practice that can better accommodate their busy lifestyles. Indeed, as the healthcare industry evolves from a patriarchal system in which doctors did the talking to one that gives patients an equal voice, so too has the population it serves. Technological innovation, new models of delivery, and higher out-of-pocket medical costs have transformed the passive patients of old into consumers as never before.

That's a good thing, says Glen Stream, president-elect of the American Academy of Family Physicians, noting the push toward patient-centered care requires patients to become active participants in their own care. But it also creates challenges for providers.

"I think a lot of physicians of my generation, who have been practicing for 25 years, think, 'What's wrong with how we've been doing it?' The answer is that nothing's wrong with it, but the environment has changed, the tools we use to deliver care have changed, and our understanding of what patients want and need has changed," he says, noting those who fail to adapt risk alienating their patients in the exam room, or worse, losing them to the practice down the street.

With that in mind, we sought to profile the modern American patient - who he is, how he has changed, and what he seeks from the system. Our findings not only shed light on the people behind the patients, but pinpoint opportunities to strengthen the doctor-patient relationship and sharpen your competitive edge.

They want bedside manners

From their physicians, it seems, patients seek out a specific set of behaviors: character traits they have always prized but have elevated in importance in the consumer era of medicine. "Patients more or less assume that their doctors are competent clinicians until they're shown otherwise, but what is also important to them, and what is easier for them to judge, is their doctor's behavior," says Leonard Berry, a professor at Texas A&M's Mays Business School and coauthor of a 2006 survey published by Mayo Clinic Proceedings called "Patients' Perspectives on Ideal Physician Behaviors." "As consumers, we pick up on a lot. We see body language, mannerisms, a raised eyebrow, a shrugged shoulder; things the provider doesn't see and may not know he or she is doing."

According to Berry's survey, patients want their doctors to be "confident, empathetic, humane, personal, forthright, respectful and thorough." Within those categories fall such specifics as an "assured manner which engenders trust," compassion, a personal connection that shows the doctor is interested in them as an individual (by recalling details about their life), and speaking in "plain language" without beating around the bush. Strong interpersonal skills, Berry says, go a long way toward establishing trust between doctor and patient, a key factor in determining how likely your patients are to comply with their treatment regimens.

Not surprisingly, patients in the survey who described their "worst physician" experience, relayed mirror-opposite traits, especially "perceived insensitivity" and disrespectful behavior. Their concerns about poor service ranged from a physician's arrogance in dismissing their input, to disinterest in them as an individual, and impatience in answering their questions. They were equally bothered by callousness in discussing their prognosis, the survey found, and by physicians who seemed to provide excellent service in the original visit, but failed to meet expectations they created about speed or quality at follow-up appointments.

They want value

It's clear, too, that 21st century patients are price sensitive, partly a result of ongoing economic uncertainty, and partly due to higher insurance premiums and copays. The 2010 U.S. Survey of Health Care Consumers by the Deloitte Center for Health Solutions found that 13 percent of all consumers switched physicians in the last year, and 29 percent of them did so for cost-related reasons that include changing insurance plans, wanting a doctor who was covered by insurance, or wanting doctors who charge lower fees. "They want changes, see gaps in quality, and fail to understand how a system that costs so much can be so confusing and seemingly resistant to common-sense improvements," writes Paul H. Keckley, executive director of the Deloitte Center for Health Solutions, in the survey. "And they do not want to pay more than they currently pay out-of-pocket, if at all."

Indeed, cost and convenience are driving the use of retail medicine for primary-care services, especially among Generation X and Generation Y consumers, the survey found. Some 15 percent of all consumers said they used a lower-cost retail clinic like those located at mini-malls and discount drug stores at some point during the past 12 months. The Gen Y set did so the most at 19 percent, followed closely by Gen Xers at 17 percent. That compares with 13 percent of baby boomers and 10 percent of seniors who used retail venues. Collectively, though, some 34 percent of all consumers (regardless of age) indicated they would use a retail clinic if it cost them 50 percent or less than a private practice doctor's visit.

Patients already use insurance coverage and cost to differentiate hospitals, the survey points out, which opens the door for individual providers to compete as well. "Better transparency of pricing and quality metrics, as well as the use of Web-based tools for obtaining test results and scheduling, can help differentiate provider organizations," the survey states, adding industry stakeholders "would do well to help consumers understand how their services differ by quality and how this could impact consumers' long-term outcomes."

They want service

Armed with websites that enable them to research and compare doctors, and a culture that assures them the "customer is always right," patients today also demand a better office experience. According to Stream, they increasingly rate their doctors based on what goes on outside the exam room. "From the time I made an appointment was the receptionist friendly and accommodating? Did the nurse interact well with me? How long did I have to wait for the doctor? How easy was it to get my prescription if I needed one?" he says. Patients also want advanced access scheduling for same-day visits, and more flexible hours that accommodate their work and family obligations, says Stream, noting his practice opens at 7 a.m., and sees patients until 6 p.m., rotating the physicians in his group to cover the extended hours. Indeed, the Deloitte survey found that 29 percent of consumers would use a retail clinic immediately rather than wait up to a week for a doctor's appointment.

Technology, of course, also ties in. Younger patients, in particular, want connectivity -Web-based access to their personal health records, e-mail appointment reminders, and online scheduling, says Stream, noting one of his colleagues sends Twitter messages to patients if she's running more than 20 minutes behind, so as not to waste their time. Roughly 1 in 5 of all consumers who responded to the Deloitte survey rate their interest in personal health records as "high," would switch providers to obtain access, and would be "very likely" to use a mobile device to maintain them. Separately, an online survey by the New York-based consumer health and wellness arm of marketing firm Euro RSCG found that 42 percent of respondents like the idea of online consultations to save time and money, while 77 percent are open to trying it. More men (58 percent) than women (37 percent) support the concept of virtual care, while the chronically ill are far more willing than generally healthy patients to have their health monitored remotely.

They value training

While research shows that patients strongly support a physician-led healthcare team, most say they still want their doctor to take the lead on important healthcare decisions. A 2010 survey by the American Medical Association found that 90 percent of respondents said a physician's additional years of medical education and training (compared to those of a nurse practitioner) are vital to optimal patient care, especially in the event of a complication or medical emergency. Another 86 percent said that patients with one or more chronic diseases benefit when a physician leads the primary health care team and 83 percent said they preferred a physician to have primary responsibility for the diagnosis and management of their healthcare.

Many also admit, though, that they're, well, confused about the level of education and training of various providers in the healthcare system. The same AMA survey found that 54 percent of patients thought optometrists were medical doctors, 41 percent believed psychologists to be, and 26 percent thought nurse practitioners were. As such, providers throughout the healthcare continuum should make an effort to become more transparent with patients about their role in administering care, says Martha Hayward, lead faculty on public and patient engagement in healthcare for the Institute for Healthcare Improvement. "It used to be that we had a number of indicators that would tell patients who they were dealing with," she says. "Doctors would be dressed differently than nurses, and often there would be a gender difference. Now, everybody, including specialists, are dressed exactly the same and the gender difference doesn't exist." The modern day patient is ready to trust information from nurse practitioners, doctors, and a variety of people within the healthcare setting, says Hayward, "and that's a huge change, but the patient requires and should expect the provider to introduce herself in a way that's relevant to their case."

They explore alternatives

Consumers are also continuing to branch out beyond the borders of conventional medicine. Nearly 1 in 5 patients actively incorporate alternative therapies with their conventional care, according to the Deloitte survey. Some 22 percent of patients, in fact, reported having treated a health problem with an alternative approach or natural therapy in the last 12 months, while 17 percent sought out such therapies before seeing a physician - up from 12 percent in 2009. At the same time, the proportion of consumers who report using an alternative approach or natural therapy in addition to a prescription medication rose from 16 percent in 2009 to 20 percent in 2010, while 10 percent reported substituting an alternative approach for a prescription medication.

They're complex

Despite all the noise about poor compliance with medication and treatment regimens, Hayward says it's important to remember that patients - all patients - ultimately want to improve. Their problems, however, are often far more complex than their diagnosis and providers will never be able to meet their medical needs unless they learn to communicate more effectively. "Doctors often become frustrated with patients who don't fill their prescriptions or change their diet, but if we understand that every patient truly wants to feel better then the discovery process becomes what's standing in the way," she says. "Use conversational skills to get to know your patients better. This is absolutely something that can be taught."{C}

When a 30-something obese patient, for example, who won't diet or exercise despite her diabetes, tells you she lives with her mom, dig deeper, says Hayward. She might reveal that her mother is a depressed alcoholic or that she only serves her family fast food. "Now this is no longer a patient who is 'not complying,' but a patient who has serious barriers to compliance, or really may not understand what a better diet is, she says. It takes no more time to have a friendly, conversational chat with your patients than to run through a generic 10-question list, says Hayward, and it's likely to reveal far more about how you can better meet your patients wants and needs.

Patients these days may expect more from their trips to the doctor's office, but they also hold the key to keeping U.S. healthcare costs under control and improving their own medical outcomes. To remain competitive in today's consumer-driven market, then, practices must remain focused on value and provide the service their patients seek - from advanced access care, to compassion, to Web-based connectivity.

"I think medicine and primary-care providers in particular must recognize that healthcare is a service industry," says Stream. "People have a choice and a right to their input on how they want their care delivered."

In Summary

In order to better understand today's patient base, remember these key items:

• Modern patients are savvy, price conscious consumers.

• Patients want doctors to be confident, respectful and forthright.

• Physicians who fail to develop interpersonal skills will be less effective in the exam room.

• Younger patients, in particular, want Web-based connectivity to personal health records.

• Patients still want their physician to play a central role in developing treatment regimens.

Shelly K. Schwartz, a freelance writer in Maplewood, N.J., has covered personal finance, technology, and healthcare for more than 17 years. Her work has appeared on CNBC.com, CNNMoney.com, and Bankrate.com. She can be reached via editor@physicianspractice.com.

This article originally appeared in the June 2011 issue of Physicians Practice.