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March 30, 2023
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David Burda
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Burda on Healthcare: Healthcare’s Failure to Communicate

On Aug. 24, 2022, I got my first in a series of two shingles vaccines. It’s something you do when you get to be my age. A nurse administered the shot in my doctor’s office after my annual physical with my primary care physician. The nurse said I should come in and get the second vaccine in the series in two to six months. If I waited too long, I’d have to start all over again.

That wouldn’t be good because my reaction and the reaction of most people to the shingles vaccines can be pretty strong. Think curled up in a ball in your bed alternatively shivering and then sweating every 15 minutes while every bone and muscle in your body aches and your head feels like it’s going to explode. But hey, it only lasts for about 24 hours. Then you’re good to go.

Anyway, one thing led to another, and before you know it, six months were up before I realized that I’m out of time to get the second dose. But I did remember, and I got the second vaccine on March 1. A few days late, but my PCP said that would be OK. I didn’t have to go back and start all over again. That was good.

But what wasn’t good is that it was on me to remember that I was on the clock for the second shingles vaccine. No reminder calls from the doctor’s office. No “don’t forget” emails from the practice. No ticking countdown in my patient portal. Just me and my paper calendar. Again, I’m 63.

That’s when I thought healthcare has a serious communication problem. We want to be good healthcare consumers and take control of our personal healthcare journeys. But healthcare is not all we do. We work. We take kids to college. We cut the grass. We remember wedding anniversaries at the last minute and scramble to find cards, flowers and gifts. We take care of our elderly parents. We plan and celebrate birthdays and holidays. We don’t have admins to whom we can say, “Remind me that I need my second shingles vaccine in six months. And get me a club sandwich.”

You know who does have the time? Healthcare. Healthcare is what healthcare does. There’s no reason the healthcare system can’t nudge you along on your healthcare journey while you’re busy with life. We need a little help being good healthcare consumers.

Most Discharged Patients Are On Their Own

A new study in JAMA Internal Medicine supports my opinion. Five health services researchers affiliated with such prestigious organizations as Beth Israel Deaconess Medical Center, the Carl J. Shapiro Institute for Education and Research, the Johns Hopkins University School of Medicine, the NYU Grossman School of Medicine and NYU Langone Health wanted to know whether hospitals are giving patients adequate discharge instructions to follow to keep them from coming back to the hospital or dying before they do.

They looked at discharge instructions in six communication domains, including:

  • Medication changes
  • Follow-up appointments
  • Disease self-management
  • Red flags (signs that you need to see a doctor right away)
  • Question solicitation (“Do you have any questions?”)
  • Teach-back (“Repeat your discharge instructions back to me so I know you understand.”)

The sample size was small — 33 patients discharged from two urban teaching hospitals in September 2018 and October 2019 — but likely representative of what happens at hospitals across the country every day.

Here’s what happened:

  • 27 percent of the patients who were discharged with medication changes didn’t get any instructions on the change.
  • 48 percent of the patients didn’t get explanations of why they needed a follow-up appointment.
  • 55 percent of the patients weren’t given instructions on disease self-management after they left the hospital.
  • 81 percent of the patients weren’t told of any red-flag signs that warrant immediate medical attention
  • 42 percent of the patients weren’t asked if they had any questions.
  • 97 percent of the patients weren’t asked to repeat back their discharge instructions (only one patient was asked to teach back their understanding of what they just heard).

“These findings suggest that significant gaps occur in patient education on the morning of discharge and represent a target for interventions to decrease posthospital morbidity,” the researchers said.

Makes my shingles vaccine reminder story look pretty petty.

Look Up Your Own Mental Health Benefits

Hospitals, doctors, nurses and other providers aren’t the only ones who can step up and help patients just a little more to become better healthcare consumers. Employers can, too.

One Medical, the direct primary-care provider owned by Amazon, released a report called The State of Workplace Health. The 23-page report is based on a December 2022 survey of 800 human resources and employee benefit leaders and 800 full-time employees. With subsections called “Put primary care front-and-center,” the survey and report are a not-so-subtle pitch to employers to contract directly with One Medical or provide primary-care services for the employers’ employees.

That said, the survey results pointed to the need for employers to do a better job of communicating how to use the healthcare system and their own healthcare benefits to their own workers.

We all know there’s a mental health crisis in the U.S. for a variety of reasons, and there’s not a business or company that says it’s not increasing mental health benefits and services for their employees.

Thirty-one percent of the employees surveyed by One Medical described their mental health status as average, poor or very poor in 2022. Thirty-two percent said their mental health got worse in 2022 with 78 percent saying they’ve struggled with mental health problems for more than a year.

Yet only 19 percent said they received care for their mental health issues last year. Why? Sixty-nine percent said they don’t know where to start if they wanted to use their company’s health benefits to seek treatment for mental or behavioral health problems.

Talk about your communication breakdown. Your employees have problems. You as a company have solutions. Yet you’re not educating your employees about how to use your solutions. That’s not good.

Patients Can Handle the Truth, Good or Bad

The pathetic communications performance by providers and employers is pushing some patients to take matters into their own hands, keyboards and touchpads. They’re not waiting for providers to give them the good — or bad — news, according to a new study in JAMA Network Open.

Fourteen (yes, 14!) health services researchers — most of them at Vanderbilt University Medical Center — surveyed more than 8,000 patients who looked up their own diagnostic or lab test results on their own patient portals at four academic medical centers in the U.S. in April 2022.

An overwhelming percentage of the patients — 95.7 percent — said they prefer to see their test results immediately on their portal as soon as the results are available and not wait for their physician or another practitioner to review them first and contact them with the results. That sentiment held true regardless of whether the results were normal or abnormal.

Clearly, patients are fed up with waiting for their provider to call them back, email them back or text them back with important medical information. It’s that level of frustration that fueling the customer revolution in healthcare, and I’m here for it.

Hopefully without getting shingles.

Thanks for reading.

About the Author

David Burda

David Burda began covering healthcare in 1983 and hasn’t stopped since. Dave writes this monthly column “Burda on Healthcare,” contributes weekly blog posts, manages our weekly newsletter 4sight Friday, and hosts our weekly Roundup podcast. Dave believes that healthcare is a business like any other business, and customers — patients — are king. If you do what’s right for patients, good business results will follow.

Dave’s personnel experiences with the healthcare system both as a patient and family caregiver have shaped his point of view. It’s also been shaped by covering the industry for 40 years as a reporter and editor. He worked at Modern Healthcare for 25 years, the last 11 as editor.

Prior to Modern Healthcare, he did stints at the American Medical Record Association (now AHIMA) and the American Hospital Association. After Modern Healthcare, he wrote a monthly column for Twin Cities Business explaining healthcare trends to a business audience, and he developed and executed content marketing plans for leading healthcare corporations as the editorial director for healthcare strategies at MSP Communications.

When he’s not reading and writing about healthcare, Dave spends his time riding the trails of DuPage County, IL, on his bike, tending his vegetable garden and daydreaming about being a lobster fisherman in Maine. He lives in Wheaton, IL, with his lovely wife of 40 years and his three children, none of whom want to be journalists or lobster fishermen.

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