Health care is a service industry. It is incumbent upon the provider of the service to aim to give you the best possible experience – just like any other service industry. But as consumers, we’ve lost our way. First of all, there is a growing chasm between “accepted standards” – and “evidence-based standards”. This drives our expectations - one of the primary issues surrounding health care consumerism. If you have been told by the health care marketplace, the media, and countless other lay articles, that time and countless visits is the standard, then your expectations will reflect this. However, accepted community standards of care are not the same as evidence-based standards of care. Our bottom line, our expectations, need to rise to reflect the standards found within the science of medicine.
So let’s start with a few “reality checks” and basic elements of consumerism when it comes to health care.
Reality check #1: We’ve forgotten that our health is a commodity just like our car, our house, our bicycle, our TV. When you have maintenance done on any of these, you expect the best outcome for the best price. If I can get a good service, at a reasonable cost, with a good outcome, then I will continue to utilize your services to fix my car, or my house. The process involves asking sound questions, making good decisions, and acting upon them appropriately. But when it comes to health care, we suddenly forget to ask consumer-driven questions.
Reality check #2: All clinicians are not created equal. Some are evidence-based, building their treatment strategies on well-established physiology and science-based strategies. Others – not so much.
Reality check #3: A supplement to #2 – treatment that focuses on patient-centered care does not necessarily equate to treatment that enhances financial prosperity for the provider – and vice versa. “Providing care” does not necessarily equate to “looking out for your best interests”. Over-utilization of services is a fine example of this phenomenon.
Reality check #4: Just because you have insurance doesn’t mean that the insurance plan has selected the best providers based on the quality of care they provide. For many, it’s simply a case of who would accept the established contract rate put forward by the insurance company. That says nothing about the expected outcome from the provider.
With these checks in mind, let us consider what I regard as five questions that should be answered by any clinician (physician, chiropractor, or physical therapist) in a discussion regarding your care. A frank conversation on these issues should have your clinician providing answers, and not becoming defensive with the interview process.
1. Prognosis: What is the prognosis and time factor expected in the recovery process? Cellular physiology is a wonderful thing. The response of tissue to loading and stresses is well-known and established. The clinician should be able to give you a reasonably accurate time frame and expected prognosis, dependent upon the individual and current level of health and conditioning. If not, or they hedge their bets, then consider another option.
2. Number of visits: How many visits do you expect this will require? As an example, the current national average for an episode of back pain is 10 visits. This is what has become acceptable, not what is currently optimal (something closer to 5 – 6 visits, including competent self care strategies).
3. Outcome: What is the expected outcome? When will I be able to return to modified activity? Full activity? Do you have other successful patients that can provide me with a patient perspective on their outcome?
4. Self Care: What strategies will you utilize to foster my self care? Is “care” dependent upon the actions of the provider, or on the actions (and self-responsibility) of the patient?
5. Evidence: What are the current evidence-based strategies for the care of my problem, and do you utilize them? Is the approach to treatment active and exercise-oriented, or passive and modality-oriented? Can you provide me with some information regarding your assessment and treatment approach? Clinical references?
By practicing good consumer strategies with our own health, we force clinicians to be accountable for their treatments and their outcomes, and to provide the customer with a service that meets their expectations. You’d do this for your car or your house. Why not do so for your own most valuable commodity – your health?
Photo credits: betta design
"Running Injuries: Etiology And Recovery- Based Treatment" (co-author Bridget Clark, PT) appears in the recently released third edition of "
" by S. Brent Brotzman, MD and Robert C. Manske, PT.
