Tuesday, May 02, 2006

Perception vs. Reality

From today's New York Times:
Patterns: Making Patients Happy Doesn't Make Them Well

Eric Nagourney writes, "Researchers reported yesterday that when it came to medical treatment, the satisfaction expressed by a group of elderly patients had little correlation with the quality of care they had received based on a review of their medical records."

We all know the type: the guy who works a million hours, puts in overtime, sleeps in his office on weekends, yet still seems to be always drowning. And while yes, he does work a million hours, all anyone really notices is that he's consistantly late in the mornings, or takes a few too many days off for perpetual emergencies. We also know the other guy, the one who is calm, unrushed, in at 9, out by 5, and somehow creates an image that keeps you from asking if all his work is really done, we just assume he's efficient and no one opens his drawers.

A lot of life-- and a lot of doctoring-- is about perception.

Here's a story. Years ago, an acquaintance had an awful accident with a severe vertebral injury resulting in paralysis at the scene. He was transported to a local hospital where a scan showed bone fragments in the spinal canal. The patient was then brought by helicopter to a major academic center where a renowned spinal surgeon (the only one in a multi-state region deemed capable) operated. It was a long recovery period, but the patient was able to return to work within a few months, and was eventually able to resume skiing-- by anyone's measure, his recovery was remarkable. The family, however, walked away with nothing but venom for the surgeon-- apparently he was callous with a cavalier bedside manner. To hear their tales, I had to wonder if, in their minds (though not in the patient's ambulating legs!) all the good he had done wasn't erased, or at least discredited, because of some intangible personality flaw or insensitive word.

The first time I see a new patient, I ask a lot of questions. I start by asking for permission to take notes ("just for the first session, I know it's a little disconcerting to talk to someone who is writing, but it's helpful to me") and I end the 90 minutes of interview with a single final question: "Do you have any questions for me?" I ask. I end this way so the patient won't walk feeling rattled by what might amount to an interrogation. Does it work, does it create a sense that I am approachable, that our efforts need to be teamwork, that perhaps I have some answers? I've no clue (most people come back...) but it leaves me with the perception that I tried!