Should patients ask doctors for references?

Can you imagine the reaction of most doctors if you asked for a reference?  I would be a little scared that I would be asked to leave the office by the most secure among them.  I might get a befuddled reference to privacy by the most aiming-to-please types.  I don't think they would laugh.  And I don't think I would get one.

But why not?  I get references on everyone.  Not just referrals from the neighbor or friend, but references.  I check them out.  I check out lawyers - look at their reputation.  Definitely whether they have won this type of case before I give it to them.

Clearly for employees of all types references are essential.  And in positions of authority where critical thinking skills and judgment are required, many references are checked.

We have come of age in an era where the medical staff at the hospital was "delegated" the reference checking function for all the patients.  Who better to look at the record of another doctor than another doctor.  But why, in this era of managed care, accountable care, consumer driven care, value based purchasing, do we not think that consumers of care (formerly known as patients) should ask for and check references.

So who would those references be?  They could be voluntary patients who want to comment on the equivalent of the big "Angie's List"  of doctors on the internet, it could be a letter of reference from some of the rating agencies, or better yet it could be from the emergency room physicians and nurses that see too many repeat falls from a practice or perfectly managed CHF patients who rarely come in more than once or other indicators of overall practice performance.  It could be pharmacists that routinely have to stop and call on prescriptions because of drug interactions or a home health nurse that finds the physician to be the most cooperative in terms of getting needed therapies for in-home elderly.

And yes it could be the patient who can tell you that his last physician missed diagnosed his CHF three times before he changed to this new, and excellent primary care physician!

Can you really imagine getting up the nerve to ask that surgeon for references?

I hope this is not your approach to Accountable Care...

This struck me as hilarious.  I am not sure why.  Maybe because for some it is so far from the truth but for others it just might be spot on.  The you tube animation is classic "overwhelmed but got to have a plan".  So enjoy http://www.youtube.com/watch?v=lF8bK7AJyL0

If by chance you find that you are relating it might be time to talk to someone about how you focus attention on this effort or avoid it altogether.  If you were to do so you would not be alone.  The majority of a recent survey are ignoring ACOs. 

If however you think that there is potential in your market or an imperative in your business model to change, then its time to find an expert to help guide you, in your own learning curve, in building this model.

Separate but unequal?

The Kaiser Health News reported that the uninsured were significantly less satisfied with their care, both in terms of quality and cost. Is this important news?  We have always seen care for the uninsured as a cost issue and an access issue, but have not discussed adequately "access to what?".  Health disparity data are one alarming measure, getting increasing study but relatively few fixes.  Does this says to those who have cared for the uninsured, that they do not have access to quality care.  Is this a wake up call to those providers or is it a wakeup call that there are not the same resources going into their care, and the poor know it.  I have always speculated that one of the reasons that the insured are increasingly against health reform, or government sponsored care, is because they are afraid not that it would become more expensive or bureaucratic but that they would receive the quality of care that the uninsured receive now.  A potentially dummied down version of care and services with the barriers that so confound the poor.  The red tape, the lines to wait in to get medicine, the decisions to sit in waiting rooms because at least they will get seen and tested that day.  We have a two class "system" of care and it needs to be fixed. 
What will the fix look like?  Does it mean that the fears will be realized?.  How do you raise the boat for all?

There are underutilized systems and professionals that help raise the boat for all in a very responsible way.  It means investing in both the systems for the insured as well as the uninsured and things will look different.  But will it be less care.  I don't see it that way.  I see specialty trained nurses managing dosing of chronic drugs per protocols.  I see rehab that continues for at risk or frail folks beyond the current limits.  I see chronic disease management via internet based protocols and navigation interventions.  I see navigation over hospital barriers and age adjusted risk assesments for procedures so that post op surprises are avoided.  These are connected by a network of information that works for the patient, alerting them to key changes in their own health.

Does this add cost? - yes it adds resources but it will be absorbed by the decrease in painful and expensive services that are not necessary - CHF admissions, Falls, GI procedures for at risk or frail elderly, reduction in number of prescriptions people are on.  Individualized protocols for treatment for cancers; elimination of unnecessary and painful spine surgeries.  There are many many areas where the science and information are creating choices for patients.  Giving you choices. Major academic medical centers have put these structures in place for their insured patients!

I see a day when Americans will think that they had great care because they used less of the expensive and painful care; yet knowing their chronic health issues and risks were managed so well.

Why recognize leaders?

I just read the list of the 25 leading women in healthcare - I was so excited that I am buying my ticket to salute them today.  It was thrilling. My career developed in the time when you started in the boys club, lucky to have great mentors but also unlucky to have predators that popped up in your future as "references".  It was an era that reminds us all that vigilance in equal opportunity for our daughters is constant.

But after all the effort to forge new opportunities, women are emerging within the traditional ways, but with ethics intact - possibly bruised - but less from "discrimination" than from "cultural immaturity".  Those women who emerge as the leaders have emotional maturity and cultural competence.  They get it; they know what they want to do and they know how to do it within the realm of the current culture, changing it because it makes economic and strategic sense, not because it meets some esoteric theory of fairness.


These women know what they need to get done.  They are focused.  They are unapologetic.  They are principled and charming.  They are right!  They are going after the next best thing...not the best money from the currently successful thing.  They are really entrepreneurial and they are culturally intuitive.  They are strong.

It is a joy to see them recognized.  Deb Proctor for her administrative skill, integrity, guts and ability to think globally.  Carol Keehan for her passion for the right thing and her understanding of managing the politics.  Her focus on the goal, the patient, the community and the values regardless of the detractors.  Sandy Bruce for her entre into a field of landmines and to create a determined focus to turn the organization around with quality leadership and Sally Jeffcoat for her style, guts, breath of vision and focus on the strategic success factors.

I would be remiss if I did not mention Nancy Schlicting who has wowed the healthcare community for years - for strategic turnarounds, for partnerships, for her unbelievable career and for the changes she is making for the future.  Kathleen Sebelius goes without saying is the epitome of the strong ethical politically astute leader.  But more important, she has accomplished what no others have and with grace, openness and a steel spine.

What a wonderful group of leaders!  Strength not in numbers but in individual effort!    I hope that the men with whom you share this space can recognize the substantive difference.  The leadership!