Quantity vs. quality in healthcare

Taryn Zard, Staff Writer

 

“How do you measure quality if it’s not documented?” Teri Woo Ph.D., a nurse practitioner at Providence and head of the nursing department at Saint Martin’s, has a lot to say about what is now required for physicians, and the changing relationship between provider and patient.  For better or worse, healthcare is quickly changing, both in the quantity of people and places we go to and the quality of care. Medical staff of all backgrounds are constantly rushing around, leaving us to wonder if they are even paying attention to our case—do they really listen and try their best to take care of us? There will, however, always be different factors that come into play depending on where you go, and who you see. One factor that plays a huge role in the relationship between caretaker and patient is that there are now so many options of who you can see: people can go to walk in, urgent care, or the ER because they are not able to take time off work. However, each of these places provides a different experience, especially regarding the quality of care. 

If you go to the same handful of physicians at a regular doctor’s office, they really get to know you and your medical history, but this can also be difficult for some people, due to family commitments, time, and benefits. Sometimes, it is easier to go to urgent care or the ER. Urgent care can be a great middle ground between your regular doctor’s office and the ER, as they are open longer hours, and sometimes are linked to your regular doctor ’s office, so they can have access to your medical records.  The emergency room is the most expensive place to go for medical attention. Unless it’s very serious and requires immediate concern and attention, the emergency room is not the most effective as they do not really know you or your medical history and very rarely are linked to your primary doctor’s office. They are trying to triage and see patients as quickly as possible, unless you have a serious condition or injury you are less likely to get as much attention.

Medical care centers around both convenience and time for patients, and also for doctors and other medical staff. 

“It’s a matter of convenience. I work in the urgent care now, for convenience [with teaching], not because I want to.” 

Dr. Woo explains that she hates having to work at urgent care, as she does not get to know her patients as well. She works there because that’s what is best for her schedule. Although we are now bringing to light these issues, Dr. Woo feels that there has always been a push to try to see enough patients, but now there’s a lot of behind the scene charts that need to be filled out. Physicians are burning out faster, as they feel overworked by checking many boxes on a list before they can see the next patient. The patient feels like they are not being taken seriously as the doctor tries to keep up with their charting. Medical jargon is thrown at patients, and as they are hustled out the door, they have no idea what was truly wrong and how they are supposed to fix their body. Dr. Woo said, she still sees 3-4 patients an hour, same as when she started practicing medicine in 1993. 

So why do patients feel like the doctor talks to them for 10 minutes before they are out the door again? 

Physicians are seen typing on computers, and not making the personal connection they used to, but if they were to scribble some notes only to type them up later, their charting would take twice as long. A great deal of providers are still working on the transition to electronic charts and documents, which slows down the physician. 

Melanie Matthews, CEO of Physicians of Southwest Washington, is working to assist medical professionals to better care for their patients and manage their workload. Melanie’s job is to regulate what the public needs, come up with new strategy plans, work on finance, human resources, and overall communications, with both the public and clinics. Around 25 years ago primary care providers took a seat at the counsel table to try to work out fair and contractible funding to be more cost effective. Additionally, physicians are working to improve relationships between patient and provider, and to make communication more open. One of the biggest issues we are seeing is that there is a lack of time for physicians to really talk with their patients. As Woo pointed out, there are a lot of charts, and the practitioners are all extremely busy. Physicians of Southwest Washington are working rigorously to reconnect patients with their caretakers and to better educate the population on their health. Nowadays, in the rush to see everyone in an efficient time frame, doctors and nurses tend to throw around excessive amounts of medical jargon, losing their patients along the way. Melanie’s team has a couple of ways they are going about educating people. They have regular meetings with doctors and people from the Thurston County to update and inform the population of what is going on with their health. Physicians of Southwest Washington has little brochures that are easy to read and understand. They also have little “stoplight” cards, with each color acting as a different cue card. Innovative care tools, such as the ones Melanie’s team is using, have proven to consistently have better results in patient’s understanding and personal care. Although great progress is being made, cost and quality cannot be repaired over time, and patients need to be shepherded through their issues to make sure they understand all that is going on. Melanie insists that the biggest issue that needs addressing in the medical realm is cost transparency. With a lack of understanding from patients, and the pressure for doctors to see enough patients, there is a national trend of quality decreasing, although the cost of care continues to rise exponentially. The goal is that more companies will start making an attempt to assist physicians in caring for their patients, and being clear about what tests are actually necessary and how much they are, so that “care gets better and cost declines.” Melanie wants to switch what the current trend is. The future is bright, holding health literacy for people by means of innovative, and simplistic tools to pass on information in a clear way that provides understanding to the patient—rather than just a clinical description of what is wrong.

 

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