Who among us hasn’t wondered at some point if that slew of tests ordered for ourselves or our loved ones was necessary? Or worried about the effect of repeated scans or the cost? Or if we really need that medication? More important, in the increasing complexity of healthcare, who doesn’t yearn for more conversation about why tests are ordered, and their impact in the near and short term? We aren’t always made aware up front of the pros and cons of the test, the risks, and alternatives.
Then there is the shock as the cost of those tests hit us. This is the banking equivalent of surprise fees or fine print—except it’s with our health, not our bank account. As one of the highest expenditures over time in our lifetime, patients should have an informed say in decision making with healthcare providers. And should be given time to have those conversations with physicians.
Mayo Clinic Decided to Invest Their Time Guiding and Informing Patients
To support those conversations, the Choosing Wisely® Initiative of the American Board of Internal Medicine Foundation in partnership with Consumer Reports was established. Its recommendations created by clinicians and 70 professional associations encourage trusting and transparent conversations that result in a plan for care that is: supported by evidence, not duplicative of other tests or procedures, have the lowest risks for harm, and are truly necessary. These conversations should also prepare patients for their cost impact.
A 2017 Minnesota Department of Health report review of tests, ordered by physicians in the state in 2014, validates the need for such conversations. Its results showed that $54.9 million was low value medical services, such as unnecessary imaging with the first complaint of low back pain, unnecessary x-rays for simple headaches, or cervical screening for women younger than 21, among others. Moreover, $9.3 million of those expenses were out-of-pockets costs to patients.
Actively Guiding Patients on Their Choices
“We used to think that more is better—more health care equals more health.… That’s not actually true,” Dr. Rozalina McCoy from Mayo Clinic in Rochester who worked on the health department report said. With patients consuming more information on the Internet or directly from advertisement, what may sound like a request for a service or a test is actually a desire for guidance.
To have these conversations requires health care providers being enabled to take the time to have them with patients. These conversations are strongly advocated for across the entire Mayo Clinic System, among many others in the United States.
The Choosing Wisely conversation guides patients and physicians to discuss
- Do I really need this test or procedure?
- What are the risks and side effects?
- Are there simpler, safer options?
- What happens if I don’t do anything?
- How much does it cost, and will my insurance pay for it?
“What’s needed is a culture change for doctors and patients,” MCoy said, since unnecessary care creates a potential for harm. “It’s about improving the quality and quantity of life for my patients.”
Using Design to Improve Patient Communications
New startups are disrupting the healthcare space, and they are leading the way to better patient communications. For instance, fertility clinic group Kindbody uses their custom-built patient portal to consistently communicate to their patients about their Summary of Benefit and Coverage, right after their first appointment. Doctors send detailed notes via the portal following each set of tests. And nurses send follow-up messages to phone calls via the portal, so that the information is conveyed in a convenient way for the patient.
Kindbody has been recognized for its usage of design as a way to improve the customer experience and address the kinds of gaps in communication that customers have historically experienced in the healthcare space.
Whether you’re an old brand or a new one, there is so much we can improve when truly put the customer at the center of our decision-making.
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