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Friday, March 23, 2012

The Engaged Patient



While on my travels back to Canada I found the editorial page that I removed from the Globe and Mail from March 5.  The editorial was entitled the “engaged patient”. 
Maybe the editor from the Globe is a reader of Making Medical Lab Quality Relevant because I have been on this theme for the last while.

One of the adages from our Quality Management course is that of all the Quality Partners, the singlemost important driver of quality is the Public, because once the public is engaged, politicians have to listen.  We may not necessarily like what happens next, but at that point it probably is fair to say that whatever happens, we brought in on ourselves.  

 I think the choice of words for the title of the editorial, the engaged patient, was interesting.  By the change of one letter it becomes the enraged patient, and all to often one leads to the other rather quickly. 

If I have issue with the editorial, it is the choice of the issues that they highlight; parking spots, and hospital food, and of course wait times.  If these are what most Canadians are complaining about, then we are running a pretty good medical program.  Or they are even  more in the dark than I imagine.

There are some real issues and the laboratory is often front and centre because that is where most of the diagnostic information comes from.  

For years we have bemoaned the quality and interpretability of our reports.  We have blamed the absence of simple and plain language on the Laboratory Information System (LIS) software.  If that is the case then it is time that we do something about it.  Creating reports that many physicians can’t understand is intolerable.  Providing these reports to patients is inexcusable.  

Providing tests that are fast and easy to perform, but which are insensitive and non-specific is not acceptable.  Many of the rapid tests are about 90 percent sensitive and have a specificity at about the same level  Sounds good, but when these tests are routinely overused on patients with a low likelihood of having disease, the value of the test drops down to about the same as a flip of a coin.
 
When we allow laboratories to hide their incompetence by “cheating” on their quality assessment testing, or when accreditation assessments are a 2 hour visit rather than a real inspection, confidence in their performance would drop if patients and physicians were to find out.

And we have already seen what happens when breast and other cancer testing is not done with precision.
 
Going back to the editorial, one of the solutions that is correctly identified is COMMUNICATION.  And they are right ... almost.  I was amused when they suggest that medical organizations should be at least as good at giving information as the airline companies.  “When a plane is late, passengers are told why”.  Give me a break.  One thing you can say with almost total certainty is that the airplane information is more about mushroom farming than information sharing; you cover the mushrooms with dung and keep them in the dark.

But communication is a key answer.  Get the well informed patient advocate groups engaged now.  They will help use get rid of the “fast and easy and wrong” tests, and take Quality seriously.  And we will learn to how to use plain language.
 
Our future depends upon it.

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