On patients, customers and consumers

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Candace Stuart - FOR LEAD ONLY - 157.40 Kb
Last year Pamela I. Hartzband, MD, and Jerome E. Groopman, MD, of the Beth Israel Deaconess Medical Center and Harvard Medical School in Boston, published a perspective in the New England Journal of Medicine that lamented the shift in terminology from “patients” to “customers” and “consumers.” They argued that use of such language changed the patient-doctor relationship to a commercial exchange.

Whether tagged as patients or consumers, the people who receive medical care appear to be getting more involved in decisions that affect their health and reimbursement for that care. For instance, starting this year, the Centers for Medicare & Medicaid Services (CMS) may begin withholding 1 percent of payments to hospitals that score low in patient satisfaction as part of the value-based purchasing program.

Perhaps not surprisingly, a recent study that linked cardiac performance measures and the Hospital Consumer Assessment of Healthcare Providers and Systems (HCAHPS) survey found poor performers also tended to fall into the lower ranks for patient satisfaction. The authors cautioned policy makers to better understand factors behind patient dissatisfaction to ensure they are modifiable, otherwise some hospitals may be unfairly punished.  

In another study, researchers looked at resource utilization and use of a decision-making tool by patients at low risk for acute coronary syndrome who present at the emergency department with chest pain. The tool is designed to educate patients about their risk of heart attack. The researchers found that patients who used the tool were less likely to request stress testing, with no major adverse cardiac events after discharge. They also noted that use of the decision-making tool did not diminish patients’ trust in their physicians.

“Informing patients of their risk and engaging them in the decision-making process may enable physicians and patients to work together to choose an approach to evaluation that is more in line with what patients want, without negatively affecting the results of their healthcare,” they wrote.

The relationship, at least in this instance, seems non-commercial. But Hartzband and Groopman may have a point in the case of social media, which the Health Research Institute at PricewaterhouseCoopers U.S. reported is a critical vehicle for engaging patients/consumers. “One-third of consumers now use social media sites such as Facebook, Twitter, YouTube and online forums for health-related matters, including seeking medical information, tracking and sharing symptoms and broadcasting how they feel about doctors, drugs, treatments, medical devices and health plans,” according to the report.

The virtual world lacks that face-to-face interaction of physician and patient. While the decision-making tool may have shortened that exchange, it didn’t supplant it.

There indeed may be a difference between patient-centered care and consumer-oriented care, but there also may be opportunities, such as with the decision-making aid, to marry the two with good outcomes.

Is this a slippery slope or a new and better system? Email me and share your thoughts.

Candace Stuart
Editor, Cardiovascular Business