A few weeks ago Carly and I were away on vacation in Bali and on an excursion to visit some of the local artisan shops outside of Ubud. We entered a batik (special Balinese textile) shop with plans to browse and maybe pick up a sarong as a gift for my mother. Upon entering, our plans changed. The shop had been set up to give the visitor an idea of how the batik was made before you could see the final product and make purchases. It turned out that each finished piece went through a careful and artistic process of drawing an image, painting with wax, and dipping in dye that was repeated over and over again to create the beautiful and colorful images decorating the cloth. Actually witnessing and understanding this process made us much more interested in the batik and substantially increased my desire to buy some. Retrospectively, I was surprised at how understanding the production process and the work that goes in to the final piece impacted my appreciation (and willingness to pay) for it overall.
Similarly, when I stumbled across this article from Kaiser Health News, What Patients Gain by Reading Their Doctor’s Notes (http://www.medscape.com/viewarticle/845759) it immediately resonated with me. I recalled an experience on the wards at SFGH a few weeks ago. My Sub-I received a call about a patient who needed an IV for a contrast CT and who was a difficult stick. Several RN’s had tried and our PICC nurse who usually puts in difficult IVs was away. When my Sub-I and I arrived to the bedside with our ultrasound machine the patient was annoyed and upset at all the needle sticks and failed attempts but he begrudgingly agreed to let us try with the ultrasound. I tied off the tourniquet and set up the ultrasound and began explaining what I was doing and seeing on the machine step by step to the Sub-I. As I demonstrated how small the veins were and how they looked different from the arteries on the ultrasound, the patient spoke up and said, “wow, I can see why this is so tough without the machine.” As we got the IV set up and he thanked us for our efforts and his anger about the failed attempts seemed to have evaporated. All in all, it had taken about 15 minutes, but this patient was able to see and appreciate the efforts that his team had gone through for his health.
In contrast, I recalled a recent experience on the wards when after hours of calling various consultants to get final recs, doing an MD to MD call to get a patient placement at a SNF, and communicating with our case manager to set up transport, I entered a patient’s room only to find them irate and upset that they were still waiting. They felt like our team had done nothing that day and they were stuck in the hospital waiting for someone to pay attention to them and just call a cab.
Unlike many of our procedural colleagues, on the medicine wards much of our time and energy is spent thinking, reading, and communicating with other members of the health care team- all of which is largely invisible to the patient sitting in bed on the ward. In the article, Luthra argues that opening up doctor’s notes to patients can help increase patient engagement in their own health and make for improved physician-patient communication, with which I agree. However, when applied to the inpatient setting I see an opportunity to improve patient satisfaction and the patient experience as well. If patients had the chance to get a glimpse of the dedicated time spent developing differentials and treatment plans, working with consultants, and organizing follow up care their impression of their hospital care and their relationship with their team would improve. Knowing that what at first glance appear to be delays are really effects of the complexity of speaking to experts and that the people in charge of their care are working tireless on their behalf throughout the day even if they are not at the bedside would serve to provide reassurance and a sense of value to patients. Despite some of the very real worries (patients misinterpreting information, or doctors sugar-coating diagnoses) opening up doctors’ notes offers a real opportunity for us to enrich the patient experience while in the hospital and improve their understanding of an increasingly complex care system.