I think that too many people today do not have any sense of gratitude. While certainly gratitude is not a trait that is promoted by the popular culture, it is one that any mature, responsible adult should exhibit. When one doesn't display gratitude, it raises serious questions about one's upbringing and suggests inadequate parenting.
Gratitude is an expression of thankfulness towards someone who has done you a favor especially when they were not obligated to do so and more so when it comes at some cost to the giver. In Christian terms, gratitude towards God is one of the central themes of the Bible.
Research shows that feelings of gratitude improve one's emotional well being. Studies show that people who are more grateful also are happier, more helpful and forgiving, and less depressed than those who profess lesser degrees of gratitude.
A lack of gratitude is not limited to patients and doctors. It is also evident in workers and bosses, children and parents, as well as Christians and God.
In medicine, as in other areas of life, gratitude is not due someone just because they are performing a service that they are being paid for. It should more correctly be considered thankfulness when a patient expresses their happiness to the doctor when receiving good care that they paid for.
Gratitude is due when the doctor goes beyond his obligation to the patient. Three areas in which a doctor, at an expense to him, may give the patient a free service includes providing medication samples, completing insurance and disability forms, and checking blood pressures.
When free samples of medicine are provided, the patient is getting something beyond what they are paying for and the doctor, who has no direct monetary cost for this service, is taking his and his staff's time to meet with the drug reps to receive the samples, using time and space to store the samples, taking time to prepare the samples, and spending time to answer phone calls for patients' who request them. When a patient receives them, gratitude is due.
Doctors often will fill out the cumbersome paperwork involved with insurance, work release forms, and patient assistance forms. The doctor is only obligated to complete insurance forms if they are a member of that particular plan. Filling out FMLA papers and other disability forms required by a patients' employer are not included in the office visit charge. The exception being with workers' compensation claims. The patient assistance forms required by drug companies to provide patients with free samples are especially burdensome and time consuming.
Many offices charge for these forms to be completed. Indeed the AMA and other professional organizations consider it acceptable and ethical to charge separately for this extra work. When it is done at no charge to the patient, gratitude is due.
Even blood pressure checks performed by an office nurse can ethically and legally be charged to the patient. The doctor is paying for his nurse's time and for the equipment and the facility with which and where the service is rendered. There exists an insurance code to charge for this service and many offices do so. When such a service is provided at no charge, gratitude is due.
Unfortunately it seems that the more gratitude that is due, the less that is shown.
Patients all too frequently stop in for their free samples only to complain when the staff doesn't stop every other task to immediately devote all their energy to getting the samples ready. And heaven help the poor receptionist who has to tell the irate patient that the office is out of the particular samples that he is requesting (demanding).
Multi-page forms are often expected to be completed on the spot despite a waiting room full of sick people who need cared for. At other times, a form is dropped off with the patient telling the receptionist that they need it completed that afternoon.
Having to wait too long for their free blood pressure check (often while getting their free blood pressure medicine) is a frequent complaint of some patients. It gets worse when they have to wait to for the doctor to review the result when it is too high.
By logical extension, the most grateful patient should be the one who is given the most services at the least cost. This includes patients who are provided free care and most Medicaid patients. The difference in the attitudes between these two groups is often quite dramatic.
The former group does not have a sense of entitlement. They realize that they are not due anything from the doctor. When a doctor chooses to see a patient pro bono, he does so out of generosity at a significant expense to himself. Because of this and knowing that this free service could be rightly revoked at any time, these patients tend to be very grateful.
The latter group will often display a sense of entitlement. That comes from an unfortunate system in which otherwise healthy people are only entitled to free medical care if they don't work or they work in a job with substandard pay and benefits. These patients don't realize that doctors who treat Medicaid patients do so out of a sense of obligation knowing that that the money they receive is less than the cost of providing the service.
Talk to your emergency room physicians about some of the Medicaid patients. You will here stories about ungrateful, impatient, entitled individuals who come in for chronic or trivial complaints because it is convenient for them without giving any thought to what it costs to the taxpayers to provide this service for them.
At its root is that sense of entitlement. If someone thinks that they deserve something, they will not be grateful, and usually not even thankful for it. Remember this when you hear a politician suggest that people should be "entitled" to free health care. Anything that is not paid for in some manner, not necessarily monetarily, is soon taken for granted, not valued, and therefore soon to be abused.
7/24/07
7/3/07
WHO'S YOUR DADDY?
I think too many people in health care are paternalistic when it comes to providing information to patients. This group includes many, if not most, doctors and hospital administrators both locally and nationally.
There exists an inevitable movement to provide people information on doctors and hospitals. The information includes prices as well as quality measures. Having previously discussed prices on my blog, I will now focus on the effort to make quality information available to patients.
In the past, patients had to assume doctors and hospital were qualified based on third party reports. There was no direct to consumer information readily available to the average patient. There was no way to determine which doctor or hospital provided a higher quality of service.
It was assumed that if a doctor was board certified, he must have received the appropriate training in his specialty and passed an examination. Nowadays, to remain board certified, a physician must maintain continuing medical education credits through seminars or self-study courses and possibly, depending on the specialty, be required to pass the accreditation exam every few years. A failure would result in a loss of board certification, but not of the license to practice medicine.
Medicare would require hospitals to pay a third party to audit themselves every few years to assure the quality of care, and more importantly to the inspectors, and that the paperwork was up to date. Again, no information was available to patients other than whether the hospital passed or failed an inspection. A failure would result in the hospital no longer being allowed to bill for Medicare services. This would effectively shut a hospital down.
As patients are becoming much more sophisticated about their own health and the health care system in general, a demand has developed for more information. People want to be able to compare doctors and hospitals just like they compare car makes and models before making a decision on where to spend their health care dollars.
There are several inherent problems with trying to compare doctors or hospitals. A car make or model has a well defined service record and resale value. People don't. A patient might not get better compared to another one because of a multitude of reasons with the quality of the health care provided being merely one.
A doctor might have more elderly patients, more acutely ill or injured patients, or other demographic differences based on the location and type of practice, even within the same specialty. The socioeconomic condition of the patients might impact the compliance and ability to afford medications.
Comparing hospitals will have similar problems. Even after accounting for the difference in the size and location, considerable, confounding variables will exist making it difficult to fairly compare one hospital against another.
Another difficulty to be overcome will be the motivation of the reviewing organization. Unfortunately there is no Consumer Reports for health care. Health care quality cannot be tested in a controlled laboratory setting. Some groups do not divulge what information the assessment is derived from, but will provide that, for a nice fee, to the doctor or hospital so they can work on "improving" their rank with that specific group.
Who will be watching the watchmen is a question that should be asked of these self-appointed raters. There is tremendous opportunity to slant results for political or financial gain.
The upside will be that too much and conflicting information is better than the current situation of too little information. Most people will be able to sort out and compare information from different organizations to draw their own conclusions on the quality of different doctors and hospitals. Indeed they do so now based on a far lower quality and quantity of information, largely word of mouth.
Certainly some people will draw the wrong conclusions from the information given, but the American Way has always been for people to have the right to make poor choices. And a poor choice is less likely if it is also an informed choice.
There exists an inevitable movement to provide people information on doctors and hospitals. The information includes prices as well as quality measures. Having previously discussed prices on my blog, I will now focus on the effort to make quality information available to patients.
In the past, patients had to assume doctors and hospital were qualified based on third party reports. There was no direct to consumer information readily available to the average patient. There was no way to determine which doctor or hospital provided a higher quality of service.
It was assumed that if a doctor was board certified, he must have received the appropriate training in his specialty and passed an examination. Nowadays, to remain board certified, a physician must maintain continuing medical education credits through seminars or self-study courses and possibly, depending on the specialty, be required to pass the accreditation exam every few years. A failure would result in a loss of board certification, but not of the license to practice medicine.
Medicare would require hospitals to pay a third party to audit themselves every few years to assure the quality of care, and more importantly to the inspectors, and that the paperwork was up to date. Again, no information was available to patients other than whether the hospital passed or failed an inspection. A failure would result in the hospital no longer being allowed to bill for Medicare services. This would effectively shut a hospital down.
As patients are becoming much more sophisticated about their own health and the health care system in general, a demand has developed for more information. People want to be able to compare doctors and hospitals just like they compare car makes and models before making a decision on where to spend their health care dollars.
There are several inherent problems with trying to compare doctors or hospitals. A car make or model has a well defined service record and resale value. People don't. A patient might not get better compared to another one because of a multitude of reasons with the quality of the health care provided being merely one.
A doctor might have more elderly patients, more acutely ill or injured patients, or other demographic differences based on the location and type of practice, even within the same specialty. The socioeconomic condition of the patients might impact the compliance and ability to afford medications.
Comparing hospitals will have similar problems. Even after accounting for the difference in the size and location, considerable, confounding variables will exist making it difficult to fairly compare one hospital against another.
Another difficulty to be overcome will be the motivation of the reviewing organization. Unfortunately there is no Consumer Reports for health care. Health care quality cannot be tested in a controlled laboratory setting. Some groups do not divulge what information the assessment is derived from, but will provide that, for a nice fee, to the doctor or hospital so they can work on "improving" their rank with that specific group.
Who will be watching the watchmen is a question that should be asked of these self-appointed raters. There is tremendous opportunity to slant results for political or financial gain.
The upside will be that too much and conflicting information is better than the current situation of too little information. Most people will be able to sort out and compare information from different organizations to draw their own conclusions on the quality of different doctors and hospitals. Indeed they do so now based on a far lower quality and quantity of information, largely word of mouth.
Certainly some people will draw the wrong conclusions from the information given, but the American Way has always been for people to have the right to make poor choices. And a poor choice is less likely if it is also an informed choice.
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