Category Archives: Patients

Healthcare Compass: Comparing primary care quality in Massachusetts

Massachusetts Health Quality Partners (MHQP) just launched Healthcare Compass, an informative and easy-to-navigate site for patients seeking comparative information on the quality of physician practices in the state. The site presents data on 19 elements of patient experience and clinical quality for adult practices and 14 for pediatric practices.

For example, patient experience includes feedback on how well doctors communicate with their patients and willingness to recommend the provider to family and friends. Clinical quality includes measures such as yearly follow-up to monitor patients on long-term medication and appropriate use of imaging for lower back pain.

I tested the site out and recommend it for those who are seeking a new primary care doctor or who are curious about how their current practice compares with others.

Local practice comparison

Local practice comparison

Here’s what I especially like:

  • The information presented is based on sound methodologies. Sample sizes are significant and where there is insufficient data (pretty rare for the practices I reviewed) no rating is given
  • The ratings are done on a three point scale (full circle, half circle, empty circle) and all three ratings are used, even for some of the top practices
  • It’s possible to compare multiple practices on one page
  • Each rating has a clickable link that provides four tabs: a summary of the measure and how it’s derived, what you can do, what your doctor can do, and helpful resources
  • Every comparison page can be emailed or printed
  • In general, the ratings are consistent with my perception of the strengths and weaknesses of the practices with which I am familiar
  • The organization behind the ratings (MHQP), is an independent, multi-stakeholder collaborative whose goal is to provide useful, unbiased information. You don’t see advertising on this site or some other business model that exploits the consumer

Of course, one website is not going to provide everything one could want. I do have a wish list of things I’d love to see, perhaps in future iterations of the site

  • Information is presented at the practice site level. There is no information on individual physicians. The practice site level does have real advantages: many of the measures are more reflective of the practice than the doctor, it helps with achieving statistical significance, and it keeps physicians from rebelling against the ratings. Still, some measures such as “how well doctors communicate with patients” are doctor specific and in my experience there is real variation within a practice
  • Users can compare specific practices that are close to a specific zip code or address. That’s useful but it prevents patients from generating a ranking of the top practices. I would be willing to travel if practices elsewhere were significantly better than those near my home
  • The measures are all interesting and useful on their own, but there’s no composite measure. The closest is “willingness to recommend,” which incidentally is the only measure expressed on a percentage basis. My practice gets a top rating on tests to monitor kidney disease and a poor rating on yearly follow-up to monitor patients on long-term medication. It’s hard to make a decision on that basis
  • The physician search functionality is somewhat weak. Put in a name like “Smith” and the site will bring up several practices but without revealing which Dr. Smith it is. (Joe Smith? Patti Smith? Smith Wesson?)
  • The information is limited to primary care. I don’t know that MHQP is in a position to do much about that in the near term but I put it out there because it’s important

All in all, Healthcare Compass is a great edition to the resources available to consumers.

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By healthcare business consultant David E. Williams of the Health Business Group

First Opinion: Online doctor consults for the masses (podcast interview)

Hey doc, let's chat

Hey doc, let’s chat

The dominant trend in primary care is toward large group practices where more and more patient encounters are with NPs, PAs and other professionals rather than MDs. Co-pays are rising, and so-called patient-centered medical homes are leveraging electronic health records in the pursuit of “population health.”

Against this background, First Opinion, an iOS app, is going more or less in the opposite direction. The company allows users one free text-based consultation a month. Additional consults cost as little as $2, while unlimited sessions are $25 per month (the same as my primary care co-pay). What’s more, once a user is assigned to a physician they stay with that doctor –they don’t get switched every time they connect.

I tested out the service and think it has some potential. It’s a take on the concept of “virtual medical tourism” that I proposed years ago. My physician is in India –technology lets us bridge the long distance.

In this podcast interview, I discuss the company in depth with Dr. Vikram Bakhru, First Opinion’s Chief Operating Officer.

By healthcare business consultant David E. Williams of the Health Business Group

 

Why the individual mandate is important

Be careful

Be careful

As a reasonably young and healthy person, freelance social worker Tammy Boudreaux wasn’t a big believer in health insurance. But then she hurt her finger. She paid out of pocket for emergency room care, but then when the finger didn’t get better she realized she’d have to pay a heck of a lot more for additional medical treatment and rehab.

Thanks to Obamacare she was able to get reasonably priced health insurance even though she had a pre-existing condition –in her case a finger that was certain to need surgery and therapy. A week after signing up for an Obamacare plan on the exchange she had surgery followed by rehab and other services.

I’m glad Tammy was able to get insurance and that she’s now a proponent of Obamacare. But let’s face it, Blue Cross isn’t going to do so well if everyone is like Tammy, only signing up once they need services. Blue Cross lost money on Tammy right away. If they’re lucky she’ll be profitable a few years down the road if she sticks with Blue Cross and gets and stays healthy.

For insurance to work, there needs to be a broad pool of customers who cost very little to make up for the few who cost a lot. That’s the purpose of the individual mandate, and it’s a good reason for it.

You can’t wait to buy fire insurance until you smell smoke and you can’t get life insurance after you’ve been diagnosed with a terminal illness. As a result people sometimes have losses for which they can’t make a claim. But health insurance is different. As a society we aren’t –and shouldn’t– be willing to tell people “tough luck” if they didn’t buy health insurance. But it’s not fair to health insurers to make them take all sick people who are sure losses without giving them the benefit of more customers who are healthy.

Republicans have been very slow to lay out the “replace” part of “repeal and replace.” One reason is that while it’s easy to get people riled up about the individual mandate, it’s hard to propose a fiscally responsible alternative without shutting people out of the system. The Republican plan of 2014 calls for insurers to accept customers with pre-existing conditions who have maintained “continuous coverage.” In other words, if someone acts like there’s an individual mandate by buying insurance before they need it, they can continue coverage once they get sick. If not they’re shut out. Doesn’t sound like much of an improvement, does it?

 

photo credit: watchingfrogsboil via photopin cc

By healthcare business consultant David E. Williams of the Health Business Group

 

 

Should you trust your doctor more than Wikipedia?

Who can you trust?

Who can you trust?

A BBC article (Trust your doctor, not Wikipedia, say scientists) reports on a US study that finds errors in Wikipedia for 9 of the 10 most expensive conditions. According to the article:

“[Lead author Dr. Robert Hasty] added the ‘best resource’ for people worried about their health was their doctor.”

So scientists have shown that Wikipedia provides inaccurate information and doctors provide accurate information? Not really.

The study in the Journal of the American Osteopathic Association did indeed conclude that Wikipedia articles had errors. But the study has serious limitations.

The reviewers didn’t seem to agree with one another on what the errors were, either because the methodology for the study wasn’t sufficiently rigorous or because the reviewers didn’t do a good job of following it. In addition, the definition of an error was whether there was a difference between Wikipedia and the peer-reviewed literature, but as the authors point out, peer reviewed sources don’t always agree with one another.

The study says nothing about whether physicians provide the most up to date information, so we really can’t compare Wikipedia with physicians. The BBC headline is misleading.

The BBC article also misses a larger and more significant point. Experienced physicians do much more than spout the latest peer-reviewed facts about a condition. They integrate clinical symptoms and findings with their knowledge and experience to generate appropriate diagnoses and treatment plans for each individual patient. Even patients who have access to and can comprehend superior professional reference resources such as UpToDate (which the researchers used as the gold standard) still need doctors.

My advice? Find a good physician and develop a relationship with him or her. To understand your condition in depth use UpToDate (there are reasonably priced 7-day and 30-day subscriptions for patients) and read the peer-reviewed articles referenced there.

photo credit: mmechtley via photopin cc

By healthcare business consultant David E. Williams of the Health Business Group

 

Patient engagement: A discussion with Susan Mende of the Robert Wood Johnson Foundation

Susan Mende, Sr. Program Officer

Susan Mende, Sr. Program Officer

The Robert Wood Johnson Foundation (RWJF) is investing in understanding and improving patient engagement. In this podcast interview, Senior Program Officer Susan Mende shares some of the lessons RWJF has learned and points listeners to a variety of resources that the Foundation is making available.

We discuss the three components of patient engagement, the role of families, the correlation between higher levels of engagement and patient outcomes, and how Aligning Forces for Quality (AF4Q) communities are pioneering patient engagement approaches.

RWJF has also published an issue brief on the topic.

By healthcare business consultant David E. Williams of the Health Business Group

 

Some docs start to get the hang of online reviews

Doctors Check Online Ratings and Make Some Changes in the Wall Street Journal starts out like many articles on the topic: by giving physicians the opportunity to vent about the evils of online reviews. We hear docs complain that reviews can be unrepresentative, that drug-seeking patients who are denied Vicodin write spiteful things, and that doctors sometimes have to give difficult news that patients don’t like. Oftentimes this feedback from doctors is merely hypothetical and provides evidence that they don’t actually go online and look at the reviews.

But this article is better than many, and it goes on to report that most physicians reviews are actually positive and that the reviews are reasonably well correlated with objective quality measures.

I also sense from this article a turn for the better in the evolution of online reviews and physicians’ reactions to them. One practice monitors the web daily for new reviews, responds to negative ones, and encourages those with issues to contact the office. Another physician looks to the reviews for constructive feedback –for example he is trying to lift his head up from the computer screen and make better eye contact.

Patients are paying attention to more than just the content of individual reviews, and physician practices would be wise to take notice. One 50 year old patient says that he is suspicious of physicians with no online reviews. “If no one is reviewing them… then I don’t feel like they are keeping up with the times, which says something about them,” he told the Journal.

Discerning patients also pay attention to whether and how the practice responds to online reviews. My sense is that patients are willing to give doctors the benefit of the doubt if they acknowledge issues and respond in a courteous manner.

Interestingly, some physician practices seem to be taking a page from the old car dealer playbook, by actively trying to influence the reviews they get. Remember when dealers used to provide a free oil change to patients who brought in their blank customer satisfaction survey? Doctors aren’t going quite that far but they are handpicking satisfied patients and encouraging them to participate.

As online reviews become more common and more important, what’s needed is a trusted third-party to make sure the reviews are representative and insightful. Commercial vendors like Vitals, RatedMDs and Healthgrades do a decent job, but there’s also a role for non-profit initiatives like the DOCTOR Project that apply rigorous approaches to provide the best information possible.

By healthcare business consultant David E. Williams of the Health Business Group

 

DOCTOR Project launches consumer-friendly reports on physicians (transcript)

Jim Chase, president of Minnesota Community Measurement

Jim Chase, president of Minnesota Community Measurement

This is the transcript of my recent podcast interview with Jim Chase, president of Minnesota Community Measurement.

David E. Williams: This is David Williams from the Health Business Blog. I’m speaking today with Jim Chase. He is president of Minnesota Community Measurement.

Jim, thanks for your time today.

Jim Chase: Hi, David.

Williams: Jim, Minnesota Community Measurement is managing a new initiative called The DOCTOR Project. What can you tell us about it?

Chase: Well, this is the project we’re hoping will build new ways for people across the country to be able to share and find reliable information about healthcare performance. Things have changed a lot in the last couple of years. There are regions that have pretty robust information on the performance of providers and the communities in healthcare. And this is the first time we’ll be able to put information together across communities so a national employer or a national publication can use it.

Williams: I understand there’s a goal to work with ten communities to develop consumer-friendly reports. Have those communities been selected yet? Is there an opportunity for new communities to join? Where do things stand?

Chase: We’re in the process of contacting these ten communities that we know could be ready for the first publication, which will probably be in 2015. We’re working with them over the next few months to identify what data they have and finalize the agreements. We’re getting the word out as we’re finding that others who weren’t aware of this are interested in joining. So we expect this to be an ongoing process. There may be some who aren’t ready today but will be in a few months.  So, we’re hoping to get this started with the first ten but we hope that this gets people interested and that we’ll see more communities participating in the future. I also hope this is an opportunity when the information comes out, that people in other communities will ask, “Why can’t I get this kind of information on my physician?” And we’ll see a growth in areas that want to participate.

Williams: Jim, the term communities is a little bit vague. How big are these communities? Are they whole states or regions? Are they towns or cities?

Chase: It varies a little bit. There are several initiatives that are statewide. There are  statewide initiatives in California, Minnesota and Massachusetts.  Also communities around Cincinnati and Cleveland, OH. So we’ll see a mix there, but we want it to be large enough to be of interest to a national organization. We realize that not everybody is able to be statewide at this point.

Williams: I understand the initiative is focused on consumers. So, assuming your project gets going and is a success over these communities, what would it mean for consumers? How will it help them on a practical basis?

Chase: It’s interesting, in almost every segment of our economy active consumers drive improvement and value, and the same control can hold true for healthcare. So, making available this information we found in our own communities has motivated the healthcare community to take steps to improve the outcome and value of the care. It gives them information to where they can focus, but because it’s public, it also motivates change. And we also think this information can help the patients themselves get better care. Surveys have shown that more people want information to help them choose a provider that’s best for them.

We also plan to combine provider and performance information with tools and other resources when we put this out. It helps patients get better care for themselves. How do they work with their physician? What kind of questions can they ask? What can they do to help themselves get better outcomes?

Williams: I know you mentioned publications and talking about 2015 for an initial publication date. I also saw that Consumer Reports is involved and I know that they’ve been involved in some prior work that you have been associated with as well. How is Consumer Reports involved in this DOCTOR Project?

Chase: This is actually building on a project that we did with them in 2012 and ’13, where three regions – communities in Minnesota, Wisconsin and Massachusetts – partnered with Consumer Reports to publish an insert in their magazine with the local data that we had. And one of the things we found from Consumer Reports was they really needed to be broader to affect more of their subscribers. So, they’re going to be a really important partner in this work. We hope to publish results in some issues of their magazine next year.

And they bring some really important things to the mix. They have an audience of subscribers that are used to using this data, this kind of information, to make choices. And they can get the information out there to a lot of people. That was very important to us. There are a lot of subscribers in Minnesota. We want to be able to take the data  in all these communities and get it to where people are and where they’re looking for information.

They also have a lot of experience on how to present information, so it’s useful for consumers. Many of us in the healthcare industry are used to talking to physicians in the hospital about this kind of data but we haven’t had as much experience in working with consumers. So it’s a great opportunity to partner with them, with their expertise on how to talk plainly to a knowledgeable consumer audience and get them information that they can really use to help themselves.

Williams: Jim, you mentioned that some data is available in different communities and there’s sort of a mix between communities that are well-served and those that are less-served. I know that you can go to the Web and find commercial vendors where you can search for information on your doctors. Then at the federal government level, you’ve got sites like Physician Compare.  How does the effort that you’re talking about here differ from what’s already out there?

Chase: One thing that we know that’s different about healthcare from many other environments is if you ask the public, “Who do you trust for information like this”, they say, “My doctor.” And so, that’s a little bit of a challenge. We don’t want that information to be biased and just have the doctors’ perspective but we know we need to get buy-in from the local providers that this is good and useful information. So, that’s the reason why we’re working with these multi-stakeholder groups in these various communities to be able to have a table where they sit down and get buy-in, both in the local medical community that data is accurate and useful for care, but also other stakeholders such as patients, employers and health plans to push for information that’s really useful for the consumers.  And it’s that balance, I think, that is going to give us the most useful data, showing where there’s variation, room for improvement and help us take the data to where the people are.

Williams: You mentioned that the project is getting going now and you expect to have some initial publication in 2015. What’s the time frame for this project? Is this something that will start up and wrap up or is it meant to be ongoing?

Chase: It’s ongoing. Much of this year is going to be collecting data and doing the validation and comparisons and packaging it. We hope to have the initial publications in early 2015, but we want to pilot it there and continue to have it be a function where it can grow. We can add other communities and we can actually move to other national audiences that may have an interest. Again, one that we know that is interested is Consumer Reports but we hope there will be others such as national employers, or other organizations that need data on a national basis that would be interested in working with us.

Williams: You’ve been talking a lot about data that’s derived from the community and the medical providers there. What about data that’s coming from patients? The information that patients are generating about their own outcomes or their own experiences. You certainly see a lot of that on the Web these days as well. Does that fit into this project or would that be outside the scope?

Chase: No, it’s absolutely something that we also hope to investigate and I think the key here is we know that the public would like to have more information about patients like them and are willing to accept information in many other settings (and I think they will in healthcare) about what did other patients or other people that interacted with the system think about.

One of our challenges in healthcare has been it’s really hard with these local healthcare areas, the diversity across the communities, to get enough patient volumes. So, this is big enough for people who want to respond to really make that data reliable. It’s an opportunity, I think, if we can bring some of the data that comes from providers locally to the public. We can also ask the public to share information that they have about the providers. And so, it’s a very interesting exchange of data that would benefit both – clinicians who are trying to figure out how to improve the care but also patients who are trying to find out from other people what are they thinking and what kind of experiences do they have.

Williams: A lot of the information that’s out there, and I think also the focus with the prior work with Consumer Reports, is on primary care physicians. And I understand that’s the key point of entry for consumers in the healthcare system. Are you expecting this to focus just on primary care physicians or are you also thinking about specialist physicians as well?

Chase: I think it’s going to be a mix. Our first few efforts will probably be in primary care, because that’s where we have the most experience with data. It’s probably easier for some consumers to understand the relationship they would have with primary care, what they might expect for the care that they would get there. But I do think there’s a great opportunity for this to apply, especially when people are looking for a procedure that they may have some choice in and want additional information. I think that’s very important thing for the future.

When it comes to patient experience data, that’s something that certainly crosses not just primary care but people can get standardized information about patient experience on many specialty practices as well.

Williams: The Robert Wood Johnson Foundation is a partner in this work. What’s their role in it?

Chase: Well, Robert Wood Johnson Foundation is a great partner here. They made a major investment over the last seven years through the program called Aligning Forces for Quality in helping communities to develop this kind of information and motivate patients and providers to work together to improve care. They recognize all healthcare is local and you have to start at that level to really drive change. And things go on locally in healthcare, not just in Washington. And so, we hope this project is going to help them bring that work that they’ve done to the national stage, help it grow by getting more communities to join, and that it’ll pay additional dividends for the investments that they’ve already made in moving this kind of work forward at a community level.

Williams: Jim, this has been a very informative discussion. Are there points that we have not touched on that you want to make sure to cover?

Chase: One interesting aspect of healthcare is that this gives us an opportunity to explore things further unlike the things that Consumer Reports typically explores . If you’re shopping for a snow blower, it’s all about the snow blower. In healthcare, it’s really a combination of what the provider can do and also what patients need to do to get them better care. And so, this is a little bit of a different environment and I think one that we can address well, where we combine the information that we have from providers but also give people information about what they can do to get better outcomes for themselves in working with their providers.

Williams: Well, Jim, it’s been a great year for snow blowers in both Minnesota and Massachusetts, so I’m hopeful that the next few years will be just as good for information about physicians so that the consumers can make the right choices.

I’ve been speaking with Jim Chase, president of Minnesota Community Measurement. We’ve been talking about The DOCTOR Project. Jim, thanks again.

Chase: Bye-bye.

By healthcare consultant David E. Williams of the Health Business Group

 

DOCTOR Project launches consumer-friendly reports on physicians

Jim Chase, president of Minnesota Community Measurement

Jim Chase, president of Minnesota Community Measurement

Patients hunger for reliable, unbiased and easy-to-understand information to help them choose a physician. In 2012, community-based regional health improvement collaboratives in Massachusetts, Minnesota and Wisconsin collaborated with Consumer Reports and The Robert Wood Johnson Foundation to publish magazine inserts to help consumers in those communities choose primary care doctors.

The inserts received rave reviews, and now the original partners are recruiting additional communities to join a new, larger phase of the work, code named the DOCTOR Project. In this podcast interview, Jim Chase, president of Minnesota Community Management, discusses the new initiative, what communities need to do to participate, and how the work will help consumers. He also describes how the information will differ from commercial and government sites and how the DOCTOR Project ties in with other initiatives.

By healthcare consultant David E. Williams of the Health Business Group

Guest post: We Must Change the Way We View Addiction

This is a guest post by Joe Avellone, Democratic candidate for Governor of Massachusetts and Steve Tolman, President of the Massachusetts AFL-CIO.

Catherine was a 13-year-old in a middle class family, when she used Oxycontin for the first time at a party. Her friends took prescription drugs, and she thought it was the way to socialize. Within weeks, she was dependent on Oxycontin and spent years stealing and borrowing to feed her habit. Eventually, she moved to heroin — it was cheap and easy to obtain. For years she used heroin, falling deeper and deeper into an addictive spiral. Fortunately, after years of drug addiction she found the strength to get help. She has been sober for 10 years and is now raising two children.

Not everyone’s story ends this way.

Today we face a tragic and unprecedented health care epidemic fueled from the rapid rise of addiction to powerful narcotics, which are plentiful and highly addictive. This health crisis stems from the medicine itself. And, regrettably, we have been here before. Heroin itself was legally sold on the market briefly in the early 1900s as a cough suppressant until it was outlawed as addiction became widespread. We have recreated this tragedy with oral narcotics 100 years later. And, it may get worse with the recent approval of an even more powerful narcotic, Zohydro. The abuse of these prescription drugs has skyrocketed over the past 15 years and has precipitated a crisis of opiate and heroin addiction among young people throughout our Commonwealth. According to national survey data, in Massachusetts 9.6 percent of our citizens age 12 and older were either dependent on or abused drugs or alcohol. That figure was 23.4 percent for 18-to-25 year olds.

Hundreds have died of heroin overdose deaths in Massachusetts since November. This is only the tip of a very large and destructive iceberg growing out of sight in many of our communities.

Massachusetts has often been a leader in treating addiction problems in the past, but we are overwhelmed with the rapid rise and huge scale of this epidemic. Why?

We are failing to treat this crisis with the urgency and mobilization of resources it needs, because as a Commonwealth, we are still not seeing this tragic epidemic for what it truly is. Addiction is a public health issue, but still carries the stigma of many of our outdated prejudices. Too many of us still view addiction as a character flaw, or a moral failing, or a failure that stems from poor parenting or poor values. These old attitudes borne over generations die hard, and exhibit themselves in subtle but obstructive ways. Because addiction is a health issue, it is just as if someone has diabetes, heart disease or suffers from cancer. The stigma of addiction traps us in antiquated thinking and prejudice, preventing us from radically changing our approach to prevent further destruction.

Our “old way” of thinking about addiction is costing us too much.

Families struggle to find where their loved ones can get treatment and are oftentimes denied access by insurance.

County jails are full of youths with minor non-violent drug offenses often related to their addiction, yet they are held at a huge cost to the Commonwealth, without getting the proper treatment they need while incarcerated.

We do not have enough beds in our treatment facilities of all types across the Commonwealth.

Current medical practice is often inconsistent regarding replacement drug therapy versus full rehabilitation, often leading to confusion and ineffective treatment.

Insurance coverage presents too many barriers to proper rehabilitation and often interferes with the much needed continuity of treatment, sending our young ones back into a cycle of using and addiction.

We must have widespread re-education of physicians on pain control and proper use of narcotics.

We need to dramatically increase our efforts to educate our students and encourage discussion in our communities on the dangers of prescription drugs and heroin.

We need political leaders who will aggressively push the FDA and the pharmaceutical industry to develop and approve safer drugs that are much less addictive. We must say no to the FDA on Zohydro.

The ability to stop this tragic epidemic is within our means. But, it must start with removing the stigma. Changing our approach virtually pays for itself, and can save the lives of so many of our fellow citizens. We need a call to arms. Strong leadership from our political leaders is necessary to lead us to this new understanding, and away from the old attitudes which are holding us back. When we recognize this tragic disease for what it is — a preventable health problem — we will be able to put the pieces together to truly change the world for tens of thousands of families in our Commonwealth.

Patient failed his therapy or vice versa?

Who failed?

Who failed?

The other day I heard a physician use a phrase I really don’t like. “The patient failed his therapy,” he said. Although I don’t want to be too picky about wording, I find that formulation to be quite disempowering and depressing for the patient.

Imagine a sick patient who tries a promising drug with the hopes of improving or being cured. It’s bad enough when a drug doesn’t work, but if the patient is made to think he’s failed as well that doesn’t seem very constructive. It would be more accurate and less threatening to say that the therapy failed the patient.

Going a step further, it might also be accurate to say “the physician failed the patient,” but I don’t think doctors would want to think of it that way!

Misattribution of blame is not unique to the heallthcare industry. Another example is provided by airlines, who are eager to avoid being faulted when they screw up. In recent years I’ve started to hear airline employees say, “the flight has cancelled,” making it sound somehow like the plane itself decided not to fly. A more accurate statement would be, “the airline canceled the flight.” Now they may have had their reasons, like bad weather, but even the most modern planes don’t cancel their own flights.

But back to healthcare, I hope physicians and other healthcare professionals will be more conscious of how the language they use affects how patients feel about themselves. It doesn’t mean walking on egg shells; instead it means trying to be empathetic, and soliciting constructive feedback from other members of the care team and patients and families themselves.

I don’t mean to make too big a deal of this. In fact, most physicians don’t use this “failure” terminology these days and I’m glad they don’t.

 

photo credit: LifeSupercharger via photopin cc

By healthcare consultant David E. Williams of the Health Business Group