Yet again dealing with my mother has provided me with insights into my interactions with patients and how we attempt to deal with patient needs in general. The particular scenario has little to do with medicine at first blush. My sister and I bought my mother a Kindle. She loves to read but was beginning to have problems with chronic eye strain after limited times reading. We thought the Kindle format, the non-back lit format, and the ability scale font size would be helpful, which it was. However, she ran into a problem with the billing to her credit card which she needed to address. When she went to the Amazon Website, there was no number to call. As it turned out, you could go to the Amazon site and follow a detailed series of screens to take you to a final screen where you enter your number and they will call you. This was simply not acceptable to my mother. She wanted a number to call so she could talk to a person.
I found this very enlightening for a number of reasons, many of which are quite relevant to the practice of medicine. The scenario above is similar to a patient who has a medical problem and wants to call a telephone number, based upon the assumption that if they talk to a person, they will improve the likelihood that they will solve their problem. From my perspective as a physician who runs a large clinical operation, I see phone calls as a challenge. The universe of possible problems which can be fielded by our phone banks is unimaginably large and it has always made sense to me that any ability to collect some data before a human is assigned to solve a problem makes tremendous sense. Amazon understands this issue and they applied a new approach to dealing with their calls. Collect the data first and assign the task of solving the problem to someone who is equipped with the tools and information required. However, from a patient perspective, they frequently see their situation like my mother and her Kindle. The most efficient way to get their problem fixed is if they coudl talk to a person.
I am a problem solver. It is my world view and the perspective as a problem solver creates a lens which focuses (or perhaps distorts) how I see the world in general and what others want from both me and the world in general. As a physician, I see my encounters with patient first as an opportunity to solve problems and only secondary as an opportunity to build relationships. For others, problem solving and relationship building are inextricably linked. Where I see the face to face doctor patient encounter and the phone as a terrible tools to collect data, people like my mother see asynchronous communication tools as missing elements of human interaction which are essential to solve their particular problems. Their problems, no matter what their nature, cannot be solved without the element of human contact. I think at least part of this perspective may be tied to the idea that having a specific point of contact up front creates a personal contact and from that a personal obligation. Someone you have spoken to can he held personally accountable. In a simple world where the potential number of possible responsible parties was orders of magnitude less, that may have held true.
I suspect that letters and telephones were viewed in a similar light when they were deployed. Over time, appropriate spheres of use for communication were accepted. Certain things are best left for face to face communication; other things were recognized as being suitable circumstances for alternative communication approaches, be that letters or telephone calls. The electronic communication realm has thrown this world into chaos and the rules for appropriate use of emails, texting, instant messaging, Facebook and whatever are incompletely defined. Where these tools are deployed in social circumstances where they are not suited to supplant the nuanced communication of actual direct human contact is a problem.
I am a social animal and enjoy personal interactions. However, in my professional sphere I focus very much on what data I need in order to make recommendations directed toward solving specific problems. I see the great potential of separating the data collection functions from the social elements of medical practice. The new communication tools are likely superior to older tools in terms of data collection, particularly if we can move essential data collection outside of the valuable face to face time of the office visit. If deployed correctly, non-traditional communication tools hold the potential for actually freeing time to cultivate relationships between patients and physicians.