Thursday, September 12, 2013

Module 3 assignment for my students

This is in response to a post by Dr. Kimberly Manning of Grady hospital. I believe she is a hospitalist at Grady Hospital in Fulton County, Georgia. In other words, like many other modern physicians she is employed by the hospital to provide primary care for patients while they are in the hospital. This frees up community physicians with admitting privileges from having to come to the hospital frequently. It is part of a management strategy that may work for everyone involved. It is not the "old days" when your personal physician came to see you in the hospital every day.

http://www.gradydoctor.com/2013/08/dr- no.html

I have been following Dr. Manning's posts on her blog occasionally for several years. A surprising number of health care professional (and hospital administrators) have blogs. Dr. Manning posts frequently and share a lot about her experiences at work and with her family. She really writes well.

In this particular post she reports an event relevant to the cultural environment of medical care. It is no secret that many patients are dissatisfied with their care in part because of cultural insensitivities. There are so many potential barriers including, for examples, languages and religious differences. Hospital administrators and medical care professionals have always faced such challenges. Patients are not always reasonable. Under new policies financial revenue flows will be linked directly to patient satisfaction scores, because patient satisfaction is a proxy measurement of quality of care.

Please reflect on the situation Dr. Manning faced with this patient. Did she handle it well? It is easy to "blame" patients who may appear irrational or unreasonable. In your opinion, is the use of patient satisfaction scores "fair" to hospitals and physicians in the assessment of quality of care? Include a working link to another web page or video that is relevant to your thoughts.

18 comments:

  1. V. Stephens
    Dr. Manning is a very bright and intelligent doctor from what I have read concerning her. I love her sense of humor on how she tells this not surprisingly event. I do feel and believe that Dr. Manning handled the situation extremely well and very professional with the patient. Unfortunately that patient is not the only patients that have those stuck in the past beliefs. Many feel and believe that a doctor should be Caucasian and most definitely a male. I know from experience in my family, this situation occurs more frequently than it is talked about. An elderly person in my family stated that she was afraid of black doctors and would not be caught dead with a female doctor black or white. I was shocked at such prejudice comment but that is how she felt. I love the way Dr. Manning re-directed and addressed the elderly lady questions and concerns. Although to me, there was some prejudice going on in that room. Dr. Manning took her valuable time to make this patient to feel comfortable as much as possible with her although the patient was still insulting her in her own way, The patient even begin to direct her concerns or question toward the resident doctor that was assisting Dr. Manning but Dr. Manning continue to hold her integrity. well.blogs.nytimes.com/2009/02/26/annoying-patient-or-d...

    The question concerning should doctors be reimburse based off of scores received by patients: I understand that Medicare is about to begin reimbursing doctors and hospitals based off the rating scores of the patients. I sure hope that is not true because only hospital and doctors in my opinion will be receiving funds. There are hospital and some doctors that do not take Medicare or Medicaid in their offices or hospital. The patients that they see will have insurance or pay up front out of the pocket therefore they have money. The hospital that accept these types of health insurance do not always received the best patients and may not always provide the best care. But they work with what they have and it would not be fair for those hospital and doctors to receive reimbursement by their patients or their families. Another reason that this type of service would not be fair is because there are some patients as well as their families that cannot be satisfied no matter how well they may be accommodated. There may be patients that are drug addicts that may come in wanted to get a prescription for that quick fix and may not receive it. That drug addict can give a bad score and prevent the doctors as well as the hospital from getting paid. There are people who have Munchausen Syndrome whom may request all types of test to be performed when they know that they do not have any ailments and only wants attention and can give a bad score on the doctors and hospital. This can become very harmful to all.
    www.kevinmd.com/blog/2012/02/patient-satisfaction-kill.html‎
    I am not saying that surveys should not be performed on hospitals and their staffs as well as all medical providers but it is not fair to base reimbursement solely on the data received. Where improvement is needed it should be dealt with in a more professional way. In order to get a raise on a job an evaluation is done so shall it be done on services been provided to patients.

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    Replies
    1. Thank you. The bonus for quality is "only" a percentage, but a substantial percent. I wish there were a better proxy measure of quality of care that could be easily implemented.

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  2. Wow, it’s funny how people can be sooo offensive and sometimes downright ignorant. I honestly believe that Dr. Manning truly handled herself like a true professional. She was able to properly access the situation and handle it according to attitude of the patient, while still maintaining her cool with a smile on her face. I could imagine the difficulty Dr. Manning faced to maintain that demeanor. However, even though that patient was very much so ignorant and disrespectful, she possibly may have not known any better, due to her demographics. She’s an elderly, African American woman, possibly uneducated (due to her grammar), even arguably low income (the stereotype of Grady Hospital patients). So, she already have this misconceived perception of what a stereotypical doctor is- a pale male, which is based on what she seen most of the time.

    It is easy for incompetent healthcare professionals to blame patients for the lack of effective health care; I honestly believe that the level of difficulty that a patient gives shouldn't affect the quality of care, unless the patient is refusing treatment. Furthermore, healthcare professionals must remember along with competency, customer service is equally important as well. Emotional and mental support can be equally effective as medical treatments, which is why it’s called QUALITY OF CARE, it a total package. So, yes patient satisfaction should determine hospitals and physician assessment of whether they are providing effective qualify care. For example, my grandmother is a diabetic and recently had to get her leg amputated at the knee and is a single, elderly patient. Outside of her kids, great-grands, and a few reliable friends, she finds herself alone a lot of times due to the extensive medical care, emotional, and mental support she needs around the clock that sometimes her friends and family are unable to give her when she needs and wants it due to our busy lives. But I must say, since she has been hospitalized and now in rehab, those physicians, nurses, and all other hospital staff has truly been a big help in assisting my grandmother. They have established a personal relationship beyond just her being a patient. Every time the children and I visit she wants us to wheel her around-she in a wheelchair- so we can meet this nurse, that nurse, and so on. So, even though good/bad patient reviews may seem a bit overbearing and invasive when determining a hospitals and physicians quality of care it’s necessary.

    http://www.youtube.com/watch?v=HDZwzy_iZSQ

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  3. Yes I do think Dr. Manning handled herself well. I have mixed emotions on the use of patient satisfaction scores as an assessment for quality care. I actually work at a hospital and surveys are given out on the regular. From what I’ve experienced once encountering a patient for the first time I believe everything that happened to that patient that particular visit is going to go on the survey. Now this can be good and bad. I have provided in my eyes great customer service, I was helpful, and even went beyond the call of duty, but if a person is having a bad day this great service will not make it to the survey. This can be altered depending on what is going on. I’ve had a patient tell me “Yes I’ve enjoyed your service, but the girl at the front desk was horrible and had attitude!” I say this type of event affects or affected the survey outcome. I think the surveys should be departmental specific and may be too general. If a patient feels they’ve waited too long or shouldn’t be there in the first place, more than likely that patient will not survey well. I do understand that it is necessary to gain some information, but sometimes things are out of our control. I really can’t think of another way hospitals can get a fair assessment, but for now it gets the job done. I deal with patients face to face every day and a lot of the time patients do not hold themselves accountable for things they should; therefore if I ask you for your copay that is clearly printed on YOUR insurance card you need not to get fussy with me and make derogatory statements about how all the hospital just wants your money. Now the patient is “offended” and it is now my fault for some reason. Any survey given after will result in poor a rating sadly to say.

    http://youtu.be/rqyHldTNvUM

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  4. I feeling as if Dr. Manning was very professional; and she asked a lot of who, what and why questions to try to come up with a conclusion in order to better serve the patient. I think she stayed really calm and she didn’t speak too much, she did a lot of listening as to why the patient felt the way she did. I myself would have been very appreciative of her not wearing the white lab coat because she was looking out for the well being of her patient health. Many times I have gone to the doctor and wanted to ask the physician could they remove that dirty lab coat. Any doctor that put their patients need first and looks out for the betterment of their needs is an excellent doctor to me. But I understand the lady concern because she is from a different era where it was very rare that women and especially uncommon that black women were doctors. But times have changed and now what use to not be of the norm is of the norm. If she was younger I would say she was been a little obnoxious, but since she is much older she really don’t understand. And to many older people the white lab jacket symbolize a lot it would be like a fire fighter coming to put out a fire and not in uniform. This is were we as younger people have to step in and educate our older people like our moms, grandparents, grandmother, grandfather, dad, aunts and uncles that are from a different Era. That’s why I personally love to go the doctor with my grandmother. Because most of the time she don’t understand what the doctor is saying and will ask very irrelevant questions and make the physician feel very small. But she isn’t trying to do it for harm she is only trying to get a clear understanding as to why; they are doing certain procedures to her.
    There are pros and cons to everything. Same goes true to this survey. I’m sure this survey is suited to make the hospital and physicians’ look good because I’m sure they only record the excellent and good surveys. The bad and poor surveys I’m sure are swept under the rug and goes unnoticed. But from my understanding of the surveys it is designed to help for the betterment of the patient needs and to bring a change to the way the physicians think and how they go about helping the patients to get better health care. I personally don’t like to participant in surveys because lots of time I think they do go unnoticed and is swept under the rug.
    http://www.rand.org/health/surveys_tools/qatools.html

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  5. I feel that Dr. Manning did a terrific job considering the formalities of the situation that occurred. The lady was certainly rude but to be perfectly fair administering any form of service to the public requires patience. Therefore, I believe that health care professional have to be prepared to handle numerous situations like the one Dr. Manning faced. I feel that patient satisfaction scores are “fair” because regardless if the patient is being irrational or not, it is a healthcare physician cardinal responsibility to ensure the best healthcare possible. The quality of care does relate to how satisfied the patient is because in some instances stress affects the quality of health for a patient. Thus, when a patient is stressed anxiety sets in and patients begin to feel uncomfortable. For example, my grandmother goes to see her doctor a lot but she has a tendency to feel stressed about the visit because she for unknown reasons just don’t like her doctor. Yet, studies show that if you engage your patient then patient satisfaction goes up. For some reasons when faced with an irrational patient, doctors will shut down. Dr. Manning did not shut down, she engaged her patient which is a technique that will help healthcare professionals get to the root of why certain patients are so unsatisfied.
    http://www.modernhealthcare.com/article/20121226/NEWS/312269951

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  6. Yes Dr. Manning handle the situation very professional. It is very easy to blame patients because our prospective and their prospective especially when it comes to first impressions.
    Working in a healthcare setting in my opinion the use of patient satisfaction scores are not fair because most of the time the patients do not complete the form. Also as a result the whole organization suffers from the bad surveys. For example this patient had an bad encounter with registration and the patient said it was the ladies at the front so the nurse spoke with the ladies at the front and little did the patient know it was registration she just assume the area was the front. That's why I feel one bad experience will determine how a person completes their patients survey and how they see the organization as a whole.
    http://www.youtube.com/watch?v=piaxBtwdEzs&feature=youtube_gdata_player

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  7. This was very interesting. One would think that the 90 year old lady would be thrilled to have an African American female doctor as her physician. This is biasedness based on years of being in a cruel world (she is 90 years old, so she was born in 1923), witnessing African Americans go through eons of deep-seeded views of their worth from other races. These views and what the elderly lady witnessed in her life has tarnished the image of African Americans in her mind and has created a perception of ineptitude of any doctor outside of what she would consider normal. It is a classic case of self-depreciation (after all, she is a black woman). It is like one blogger on Dr. Manning’s post said; the shackles have been removed physically but they still exist mentally. I think that Dr. Manning did the only thing she could and should have done…keep her views to herself and treat the patient without any biasedness. Health care providers must realize (just as Dr. Manning did) that addressing cultural diversity goes beyond knowing the values, beliefs, practices and customs of African Americans, Asians, Hispanics/Latinos, Native Americans/Alaskan Natives, and Pacific Islanders. In addition to racial classification and national origin, there are many other faces of cultural diversity. Religious affiliation, language, physical size, gender, sexual orientation, age, disability (both physical and mental), political orientation, socio-economic status, occupational status and geographical location are but a few of the faces of diversity (Campinha-Bacote, 2002).

    I do like the idea of tying patient satisfaction scores to the assessment of healthcare because it helps keep the doctors honest and tied to their Hippocratic Oath. As mentioned in one of our healthcare classes, too often have doctors been careless during surgical procedures or have presented poor bedside manners without repercussion. But, issues like Dr. Manning encountered would certainly skew the results of such a system. Why, if you had 5,000 patients and 500 of those patients come into the hospital or clinic with preconceived notions like the elderly lady in Dr. Manning’s blog that certainly would create an issue. Yes, it is easy to blame patients who appear irrational or unreasonable, but this isn’t the correct approach. In understanding diversity, administrators of all kinds need to realize that despite putting forth all of the proper efforts, he or she will still have to deal with variances in their patients/consumers/citizens. The best thing, in my opinion, to do is remain professional and unprejudiced. In addition, interacting with patients from diverse cultural groups will refine or modify one's existing beliefs about a cultural group and will prevent stereotyping. However, healthcare administrators must be cautious and recognize that interacting with only three or four members from a specific ethnic group does not make one an expert on the cultural group (Campinha-Bacote, 2002).

    YouTube Video - Cultural Competence: Cultural Diversity and Healthcare:
    http://www.youtube.com/watch?v=qbP99lnXkkY

    Work Cited:
    Campinha-Bacote, J. (2002). Many faces: Addressing diversity in health care. The Online Journal of Issues in Nursing, 8(1), retrieved from http://www.nursingworld.org/MainMenuCategories/ANAMarketplace/ANAPeriodicals/OJIN/TableofContents/Volume82003/No1Jan2003/AddressingDiversityinHealthCare.aspx

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  8. In opinion Dr. Manning handle this situation extremely well. There are many stereotypes of how a doctor or any professions suppose to look. I really think people need to come out the past and move with the future. I honestly believe as long as you have a degree, great at what you do, and you know what you are doing you can dress out of the norm as long as you wont as long as you are professional at all times.

    However, in a health profession there are many obstacles a physician will go through. This was just one of the major obstacles. Cultural awareness is the self-examination and in-depth exploration of one's own cultural background. This process involves the recognition of one's biases, prejudices, and assumptions about individuals who are different. Without being aware of the influence of one's own cultural values, there is risk that the doctor may engage in cultural imposition. Cultural imposition is the tendency to impose one's beliefs, values and patterns of behavior upon another culture.




    Work Cited:

    Campinha-Bacote, J. (2002). Many faces: Addressing diversity in health care. The Online Journal of Issues in Nursing, 8(1), retrieved from http://www.nursingworld.org/MainMenuCategories/ANAMarketplace/ANAPeriodicals/OJIN/TableofContents/Volume82003/No1Jan2003/AddressingDiversityinHealthCare.aspx

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  9. Accommodating Cultural Diversity - Palliative Care: http://www.youtube.com/watch?v=_pSEni3LqEY

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  10. I must say that Dr. Manning handled her situation very well. My grandfather is very similar to the patient in her blog. One would be amazed at how many elders are “stuck in their ways” and very resistant to change. Before responding to the blog, I spoke to my grandfather, gave him somewhat of the same scenario and asked how he would have reacted. I was not surprised when his response was almost identical to the patient in Dr. Manning’s blog. He said that he would rather have a white male as a Doctor but everyone disserves a chance! I honestly have mixed emotions when it comes to customer satisfaction surveys as a measurement of quality of care. I think that it is not taken into consideration that some patients are not in the condition to be satisfied. In turn they may give a bad score and it may be perceived that they received poor care. That may not be true. In the case of Dr. Manning, her patient could have given her poor scores on her survey simply because she did not fit the demographic image the patient desired. Of course we all know that in no way can measure the quality of care she received. The link below is a video that a patient submitted to Phoebe pertaining to her procedure. I’m sure her patient survey positively reflected her quality of care.

    http://www.phoebeputney.com/PhoebeContentPage.aspx?nd=1171

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