Monday, 15 January 2018

The orientation to the patient: a health service as a "service"

Sophia Schlette

One year ago, while I was still working for Kaiser Permanente, I was invited to give a talk on primary care concepts in an adult education academy in the vicinity of Berlin. I thought I would present a theoretical framework of evaluation, based on evidence, consisting of ten dimensions, similar, but not identical, to the ten building blocks of Bodenheimer already presented in this blog. I arrived on the previous afternoon and saw the participants with a certain air of frustration in being saturated with so much theory. The models and concepts of the talk had little to do with the experience in the German medical practice or with the doctor-patient relationship in real life. In Germany, if you go to the doctor, you have to take half a day off. Wait up to 40 minutes, despite having an appointment just to have 5 precious minutes with the doctor. Typically, neither the doctor nor his employees will give any explanation, nor apologize for the delay. There is no electronic medical record everywhere and where there is, the doctor begins to read it only when the patient is present: “Here’s the recipe. Have a good day. Goodbye” This is the German system, as we know it since childhood.

Returning to my lecture, I was worried. How could I awaken the interest and raise the attendees’ spirits? How could I give this audience a presentation that would bridge the gap between theory and practice and convey, at the same time an idea of ​​a different practice, no matter how well it’s established elsewhere? I spent the night thinking about it and decided to prepare an impromptu presentation, without slides. On the other hand, I opened my personal Kaiser Permanente patient electronic file, and that's how I got the attention of the public. Through my clinical history at KP HealthConnect, we observed a provision of services that could not be more alien to German practice, and suddenly, participants woke up. They were glued to the screen, incredulous but fascinated. How come?

They saw that there are health centres where it’s possible to choose the doctor, to make visits only by electronic means, to contact the doctor via email. A system in which the doctor waits for the patient (Topol: the patient will see you now!), where the consultation time lasts between 15 and 20 minutes, where, if there is any doubt, the patient is referred to a specialist immediately, without derivation, without detours, without stress. I showed them how to choose, or change a GP: electronically, according to the criteria that may interest the person most, such as gender, age, language, professional interests, and previous experience with KP but also sympathy. For example, I can choose from 14 general practitioners who work at Oakland Medical Centre, the health centre closest to my workplace. (If I prefer, I can choose from many more within a radius of 30 miles or more around my residence). And to go on Kaiser Permanente is a system where my prescription - my medicines are packaged for me- is already dispatched waiting for me at the pharmacy closest to the exit of the centre.

Kaiser Permanente is a system where, as early as 2009, I could send a protected email to my doctor about any doubt after the appointment and she would respond in a few hours. Today, if I want, I can talk to my doctor or nurse through videoconference. At KP HealthConnect I find all kinds of digital support updated and based on evidence, in understandable wording, for example: an encyclopaedia of health, active life advice and healthy eating, incentivizing me through individualized achievable goals and compatible with my rhythm of life, groups of patients, etc. My audience wakes up and is outraged. If it’s possible to provide services like this, why doesn’t it work here in Germany? But as the subject of this post was what Kaiser does differently, I can’t here delve into the challenges of change in my own country. That will be the subject of a next post.

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