Patient’s Want Access To Care. And They Want It NOW!
But who defines what “access” means?
By George Martin, MD – Senior Medical Director for Health Integrated
As doctor and Senator Bill Frist said, “America enjoys the best health care in the world, but the best is no good if folks can’t afford it, access it and doctors can’t provide it.
But while all patients want access, actually having access means different things under different circumstances. Let’s look at three possible scenarios:
Scenario 1:
For those patients who are otherwise well, access means being seen in a timely fashion when we want to be seen. Let’s say it is Saturday afternoon and I have fever. If the fever persists and I still feel bad in the morning I will want to be seen, diagnosed and treated. No matter that it’s Sunday morning, Tuesday or Christmas Day. Day of the week or hour of the day means nothing to me. I am sick and wish to get better so that I can do what needs to be done in my life.
But who will see me in these circumstances? It is highly unlikely that it will be my primary care physician. My access options have rapidly dwindled to either an urgent care center or the emergency department. No matter which I choose, will my primary care physician (PCP) be informed? Perhaps in the greater scheme of things a copy of the encounter will be forwarded to my PCP’s office. However, my PCP will not read the material or follow up to make sure that I got well. My new medical records will be filed and only referred to in the case of a malpractice claim.
Sigh.
Scenario 2:
Your primary care physician has just told you that your mammogram came back suspicious for malignancy and you will need to have a biopsy. At this point your response is shock – “Oh my God, he just told me I have breast cancer!” – This thought going through your mind precludes all hope of a rational discussion. You allow the “system” to take over. This probably means that you will be sent to the front window to check out and they will say that Dr. Smith, the physician to whom you are being referred, is not in the office on Thursday and that the office will follow up with you tomorrow to establish when the appointment with Dr. Smith can be done.
Friday, after a nervous night for both you and your spouse, you expectantly await your PCP’s office to call. Late Friday, the anticipation peaks and you call your PCP only to be told that they were unable to get to the issue earlier in the morning and now the specialist’s office is closed until Monday. Have a great weekend. Really?!
Scenario 3:
You have a care coordinator assigned to you when you join your new health plan. As part of your intake or first visit to your provider the care coordinator takes the time to make you aware of the care coordination function. You now understand how to best assess issues. The coordinator explains about your need to ask questions so that you can better understand your situation and provides easy access for you if additional questions arise.
In either of the first two scenarios your care and issues will be coordinated and addressed. As part of the health plan in the third scenario, you have immediate telephone access to your care coordinator and your needs are promptly and effectively addressed. Ahhh.
Which would you prefer? Can you relate to one of these access scenarios? What can we do to better manage access as well as patients’ expectations of access?
Do tell! You can reach me directly at healthexecforum@healthintegrated.com, or comment directly in the blog.
As always, thanks for reading and for your input.
George Martin, MD
