Friday, April 29, 2011

FACTORY VS. CHURCH?

A man in our cancer support group spoke this week about the difference between two medical offices he'd visited.

"I wish Dr. A had seen me in his waiting room," he said. "At least there were windows there. An assistant finally called my name and led my wife and me to an examining room where there were no windows, nothing on the walls, only an old People magazine. We waited there for twenty minutes, and finally the doctor came in. Discussing it as we drove home, we both felt kind of disrespected.

"We might not have even commented on it, except that last week we'd been to see Dr. B. Now, his office is full of life. In the waiting room are plenty of plants and an aquarium. There are beautiful framed photos on the wall. We weren't put into an exam room until the doctor was ready to see us, and what a difference: carpeting, wallpaper, a window--a really homey place…"

You might think that docs are cognizant of what goes on in their offices, but often they're oblivious. Years ago, when I'd bring my father to his oncology visits, I ground my teeth as we waited and waited in the aptly named waiting room. I eventually realized the office ran a standard ninety minutes late. One afternoon, as we were leaving, the receptionist assigned us the next visit. I noted it would be at 1PM.

"Okay," I said, "we'll be here at 2:30 on the nose."

"No, the appointment's at 1."

"You know as well as I do," I said, "that we won't be taken into an examining room till 2:30. My father's eighty-five. He can't take that."

Later that day, the doctor phoned us. He told us he was appalled and humiliated. He truly hadn't known how long patients waited. He went on to make changes in his office operation, and from then on we waited no longer than ten minutes.

Treatment isn't restricted to chemicals and physical procedures. It includes esthetics, too. Does the medical office atmosphere feel like a healing sanctuary in which you're treated each moment with compassionate regard, or more like an impersonal industrial workplace? In other words, does the ambience make you feel better or worse?

In the Middle Ages in Europe, when there were no hospitals at all, churches took in the sick. The nuns (that history, incidently, is why British nurses are often still called "sister") possessed the medical acumen of the time, which was close to zero. However, their patients inhabited sacred architecture, were bathed in stained glass light, and treated with food, rest, quiet and dignity.

We needn't choose between chilly high-tech interventions and beautiful surroundings; why shouldn't healthcare comprise both? In fact, why would practitioners want to work in an ungracious setting?

Left to their own devices, healthcare's corporate owners will tend to change things only in ways that increase profits. I've long predicted that if current trends continue, we'll eventually receive diagnosis and treatment from vending machines.

That's the default, but feedback from patients--that is, customers--will have an effect. I've made it a personal practice to send e-mails to the docs I've seen as a patient, evaluating the care I was given. My messages are usually of praise, but sometimes they're critical. I encourage other patients to do similarly since there's hardly any mechanism in healthcare that honors patients' experiences.

One exception is the Kaiser Permanente system, which for the past several years has incorporated patient satisfaction into its formula for paying its physicians. Imagine what healthcare economics would look like if patient satisfaction were a major value everywhere. 

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