Doctor....what are you REALLY thinking?

Throughout the process of becoming a better healthcare manager and a supporter of better quality, I have come across again and again the need for implementation of Evidence Based Practices or EBP. Basically, EBP is "the integration of best evidence with clinical expertise, path physiologic knowledge, and patient references in decision making about individual patients" (Schumacher et al, 2003). To put it simple, EBP uses the latest technology integrated with the best available professional expertise while maintaining the patient's wishes. In a way it sounds like healthcare quality juggling. EBP is only a small part of what is called a Continuous Quality Improvement (CQI) which is the mainstay of any quality improvement of maintenance program within a healthcare organization or facility. This is essentially the understanding the quality is continually improving and adapting and as healthcare managers we must improve and adapt with it or doomed to see our organization fail miserably.

As more and more healthcare organizations begin to implement their own CQI projects and integrate EBP (as its use is rather new in the field) we must focus on what we are doing well and what we are doing not so well. First the good news. Our healthcare professionals are amongst the best and arguably the best qualified and trained individuals in the world. Their training and education is the best possible when compared to other industrialized nations. Secondly, there is absolutely, 100% no doubt that the U.S. healthcare system in general does a fantastic job of maintaining a high quality of healthcare treatments, research, equipment, and pharmaceuticals. So good of a job, in fact, that we have begun to overspend and over focus on our scientific strengths leading into inefficient use of this incredible technology. This leads us to what we do not do so well, the doctor/patient relationship. In our efforts to treat every human being the same way we treat cars, we have somehow forgotten that these patients are individuals who have the right to know what is going on and to request different avenues of treatment. This is a direct product of overworked physicians who view their opinion and desires almost as the "law". Instead of the physician viewing their job as simply keeping a person alive, physicians must begin to understand that even though their expertise may lead to the most favorable outcome, in the end the patient has to deal with both the good or bad consequences.

This "fragmenting" of the doctor/patient relationship has not always been the weak link in our continued use of EBP. At one point in our not so far of history we were forever linked to a doctor from birth to death. This individuals became a trusted and respected part of our family, sometimes even showing up to our backyard BBQ's and family events (I have the pictures to prove it). However, due to the constant migration of families, the disappearing of the traditional nuclear family, and the ever increasing strains of healthcare costs, we have begun to see a trend of individuals going through a variety of primary care physicians. This leads to little if any communication between the physician and the patient allowing for an environment of mistrust and at times hostility. So what is a healthcare manager to do?

There are a variety of ways we can begun to "reconnect" physicians with patients. Maybe teleconferencing can replace house visits, or maybe the physician can begin making patients "follow" their own blog. These all are good ideas, however they are not very practical and can even be somewhat expensive. Why not think simply, quick, efficient, and (most of all) cheap? Rather then create another hurdle for communication why not simply open up and share all the information available? Recently a study called the OpenNotes Project is looking at what happens when a doctor's notes becomes available for a patient to read. This simple yet very effective technique has proven to "improve patient understanding of their health and get them to stick to their treatment regimens more closely" (Landro, 2010). This incredible show of trust by physicians has also led to improving the doctor/patient and decreasing any hostility or mistrust a patient may have. This has often lead to better treatments, happier physicians and patients, and improved healthcare quality. However, the news isn't always sunshine and lollipops. Researchers have also found that patients may panic if the see words such as cancer or heart disease and doctors fear that patients simply may not understand what their notes are saying.

Though we still have many hurdles ahead to improve the doctor/patient relationship, such simply strategies have improved overall healthcare quality by stressing one very important factor: trust. This project has begun to take notice by many healthcare providers, chief amongst them Kaiser Permanente who may begin to publish doctors' notes on the Internet for their patients' viewing. It's incredible how such a small step can improve quality. Though I do not question the importance of such a program I do have one simple question: What to do about the terrible handwriting so many physicians have?

1. JHQ - 130 A Model Structure for an EBM Program. Schumacher, Dale N., Stock, Joseph R., Richards, K., and Joan, K. (July/August 2003). Retrieved June 18, 2010 from: webcourses.ucf.edu/webct/urw/lc4130001.tp0/cobaltMainFrame/dowebct

2. What Doctors Really Think. Landro, Laura (July 2010). The Wall Street Journal. Retrieved July 19, 2010 from: online.wsj.com