LMS President’s Message, June 2021: Patients as Consumers of Healthcare
By James Borders, MD
The pandemic has had a profound impact on how consumers of goods and services and those who provide them behave. Some restaurants have discovered the efficiencies and profitability of being confined to drive-through service, thus avoiding the space and service requirements of an “eat-in” population. In healthcare, aided by reimbursements for virtual medical interactions rendered on par with face-to-face visits during the pandemic, providers have accelerated their adoption and promotion of a virtual option to their interactions with patients. Still, there are differences in the acceptance to new alternatives to the delivery of healthcare services when one analyzes these preferences based upon the age of the healthcare consumer.
Research by the Advisory Board has helped clarify how different age groups prefer to interact with their healthcare providers. One can predict that those over age 65 are the most loyal to traditional healthcare delivery and to their physicians. They are the most resistant to virtual healthcare visits, although most would consider a virtual visit if an in-person option is not available the day requested. This group prefers weekend access over after-hours access if given the option. This group is the most loyal to a specific hospital affiliation when referred to a specialist. They are the least likely to want to travel for medical care.
It is not surprising that healthcare consumers in their 20’s are the most receptive to virtual visits, are most likely to travel for quality, are the most likely to shop price, and are the least loyal to their PCP. If an after-hours option is available, this is preferred to weekend access.
It can be predicted that the pandemic has re-shaped consumer behavior in ways that will persist long after the pandemic subsides. To some extent, this reflects a basic fact of human behavior- that habits and traditions, once formed, have a way of becoming entrenched whether or not the original motivation persists. Commercial interests competing for market share are creating new options that make commerce more convenient to consumers, and many new options for performing old tasks are certain to become permanent.
Whether a physician interacts with a patient in person or virtually, there are expectations about the interaction that a practitioner should keep in mind. Traditionalists, those born before the end of WWII, use surnames and titles and are generally reassured by formal introductions and by an awareness of your experience and credentials. They likely take offense to an assumed first-name basis and will take notice of your attire.
Baby boomers, born between the years of 1946 and 1964, will tend to rely on you to provide information but want to be involved in all decisions. They respond well to good behavior being recognized and rewarded.
Generation X individuals born between the years of 1965 and 1978 have seen scandal rock every institution and tend to be cynical and skeptical. They are less patient, want work life balance, are independent, and are less loyal to institutions. They will tend to make up their own minds based upon information they seek out on the internet. You will need to work harder to earn their respect.
Generation Y individuals (the Millennials) –born between the years of 1978 and 1998- are more diverse, are very comfortable with technology, and have had helicopter parents who have assured an affluent upbringing compared to earlier generations. They have a short attention span and need a lot of feedback and praise. They tend to be highly collaborative and cooperative once you’ve gained their trust.
Regardless of the generation of patient you encounter, there are timeless principles to gaining trust. It is easy to forget that patients of all ages seek reassurance of your competence in ways that have nothing to do with your formal medical education. While a good bedside manner should not be used to conceal incompetence, it is certainly an asset to improving the chances of gaining credibility with a patient.
New patients will have “googled” you and, based upon others’ comments about you, formed opinions about you before your first encounter with them. When they do meet you, they will study your dress, grooming, grammar, communication and listening style. Some patients have been known to judge a physician’s currency with medical knowledge based upon the dates and choices of waiting room periodical literature. The biblical principle that “one who is faithful in little is faithful in much” applies, and the wise physician is mindful of similar expectations.
I’ve often been asked how to choose a good primary care physician (PCP) when one of my patients moves to another city. My traditional answer, when PCP’s managed their own patients in the hospital, was to ask them to contact the best hospital in town and ask to speak to the nursing director of a main medicine floor. Those individuals would not only know which physicians had more favorable patient outcomes but could speak to how the physician interacts with patients and staff – often reflecting upon the awareness of the principles discussed earlier.
Yes, much has changed in the last 15 months, and some of those changes are permanent. However, no less permanent are the timeless principles that set the stage for effective physician-patient interactions to begin.
James Borders, M.D.