Quest for compliance: 3 ways practices can help patients do the right thing

I could have dreamt it, but am nearly positive I could hear the surgical team chatting for a few moments of my 90-minute wrist surgery earlier this year. I had a nerve block preventing any feeling in my arm, but while I'm guessing the sedation started to wear off a bit, I remember hearing my doctor's voice say something like, "Wow, that's really tiny," and the assistant mutter something in return. I remember listening intently but not feeling alarmed. The conversation seemed to clearly be about the bones they were working to repair, and their tone was matter-of-fact, not urgent or frustrated, and certainly not disparaging. There wasn't even any Grey's Anatomy-esque banter about love triangles or plans for the weekend, at least not that I heard (or imagined).

Although I'd like to think this description would be fairly standard, at least one $500,000 lawsuit highlights a disturbing exception. In case you missed it, the case featured an outrageous exchange between Tiffany Ingham, M.D., and her surgical team, in which she called an unconscious patient undergoing a colonoscopy a "retard" and a "wimp" and also speculated that he was gay due to his alma mater, the University of Mary Washington, a former women's college. 

The patient, an unnamed Virginia man, reportedly audio-recorded the entire procedure on his phone by accident, thus creating the appalling "caught on tape" evidence that has not just the healthcare industry but much of the general public talking.

For physician practices, some existing hot topics may heat up even more this summer:

  • Disruptive behavior: As my colleague, Ilene MacDonald pointed out in her own recent commentary, unprofessional physician behavior has been an ongoing problem for years. In fact, a December 2014 study in JAMA found that of 523 physician leaders and 321 staff physicians, 71 percent witnessed disruptive behavior in the previous month and 26 percent were disruptive at one time in their career. Does your practice have a written code of conduct? Even though no healthcare organization should need a rule that prohibits bullying patients (or colleagues), you should discuss and celebrate your values as a group. In other words, be proactive rather than reactive. Demonstrate and reinforce respect at all times--and have a clearly communicated plan to address any lapses swiftly and universally.
  • Patient recordings: We've discussed the many ripple effects of patient recordings, such as privacy, liability and practicality, throughout FiercePracticeManagement before. If you haven't yet come up with a policy to address requests to record and/or incognito recording, rest assured it's a subject that's not going away. Examples of how other organizations have responded have varied. While some healthcare organizations have banned cell phone recordings outright, others have tried to facilitate the practice by using cell-phone applications that allow patients to record doctors' instructions and send them to a home computer, according to a recent post from JD Supra Business Advisor.
  • Medical scribes: Hiring a third party to sit in the exam room and document communication that transpires may not just save time but help create useful take-home information for patients as well. This approach could potentially reduce patients' desire to take recordings, some scribe proponents have argued. I haven't heard much regarding any downsides of using scribes, and will be curious to see whether recent events cause more practices to reach a tipping point and try one.

I could be naïve, but I don't think the key problems practices should be looking at are patient litigiousness or physician misconduct. They are factors that can't be ignored, of course, but this case arose initially out of a patient's desire to go home with a verbatim copy of his physician's instructions. This could be a sign of a positive trend for physician practices. Patient compliance, after all, doesn't always happen the way physicians would like it to. Perhaps we're seeing signs that patients are becoming more engaged in their health--and are looking for tools to help them do the right things.

As a practice, how can you address that root need? Is audio-recording ideal--or can you help facilitate a solution that's even better? - Deb (@PracticeMgt)