The medical anthropologist, physician, and humanitarian, Paul Farmer once wrote, "I mean, everybody should have access to medical care. And you know, it shouldn't be a big deal." Access to medical care is so important to delivering (and receiving) quality medical care. Drs. Jaewon Ryu and Thomas Lee recently wrote an editorial in the New England Journal of Medicine ("The Waiting Game - Why Providers May Fail to Reduce Wait Times") that focused on the need to improve access to medical care - in this case, the "waiting game" referred to the time it takes to schedule an appointment and be seen by a physician, not the amount of time that you spend waiting to see the physician at the office in his or her waiting room (I briefly talked about this other issue in a blog post from 2016, "Sometimes, sorry is the best thing to say", which happens to be my most viewed blog post).
Imagine that you, as a patient, have been told that you may have a serious diagnosis (e.g. cancer, heart disease, asthma, or another chronic illness). Now, how would you feel if you were told to call and schedule an appointment with the specialist, and the specialist is unable to see you for a couple of weeks? Now, imagine that you have been waiting for a couple of weeks to see the specialist, you showed up for your appointment on time, and now you are waiting well past your appointment's scheduled time before you actually see the specialist. Finally, now imagine that the specialist spends only a few minutes with you, answers some of your questions, but then asks to see you back in a couple of months. How does all of this make you feel? Unfortunately, this sort of thing happens in the U.S. health care system just about every day. And it is not always the provider's fault - some times it is just the inefficiencies that are inherent in our complex health delivery system.
As Drs. Ryu and Lee emphasize, long waits before appointments (in other words, poor access to care) result in missed appointments (patients are much more likely to not show up for their scheduled appointment). Long waits before appointments are also associated with a greater risk of developing complications, which in the end result in worse outcomes at a much higher cost. Finally, long waits before appointments often encourage patients to seek medical care in the costlier emergency department setting. Improving access to care results in better outcomes, lower costs, and more satisfied patients (the so-called "triple aim").
We live in an age where people are not used to waiting. If you want to purchase something online, you can order it with the simple click of a mouse and have it delivered the next day (Amazon is even starting to explore same day delivery in several markets). If you have a question about something, all you have to do is search the Internet on your smart phone and the answer is right there. We have grown accustomed to instant access, all the time. It is no wonder, then, that patients are starting to demand better access to medical care. Some institutions (the Cleveland Clinic, IU Health, and UCLA Health are some quick examples, but there are many others) have started offering "Same Day Appointments" to improve the quality of care, lower costs, and improve the patient experience. If you want a good reason why so-called "Retail Clinics" have been so successful (some would even call them a disruptive innovation), look no further than access - having same-day access to a location that conveniently located on your way home from work or school at all hours of the day is really unbeatable.
Last week, I had my annual exam with my Dermatologist (I am paying for the sins of my youth - I was a lifeguard all through high school and college). My appointment was scheduled for 6:15. In the morning! I showed up at 6:00 AM, I went back to the exam room at 6:10, and my dermatologist entered the room at 6:15. I was done in 15 minutes and on my way out the door by 6:30 AM. I made it to work about 30 minutes later than I usually do. THAT is what I call access!
We need to get over the concept that having long access times is a badge of honor ("I am so important, patients will wait months to see me!"). We have to improve the access to both primary care and subspecialty physicians and providers - our patients are going to demand it. More importantly, they deserve it.
No comments:
Post a Comment