HCLDR Chat and Healthcare Mystery Shopping

Feedback from consumers and providers is a great way to make an organization work better for everyone. Once you start thinking about using these insights great changes can occur -- if there is a will to use it.

This should work in healthcare. A great discussion about the topic of patient feedback can be found here in a transcript of the #HCLDR tweetchat from Tuesday August 13 at 8:30 pm EDT. Below are the top 10 participants by mentions.

• @practicalwisdom @colin_hung @teammdrs @soulmirror @dandunlop 
• @jcs0716 @docnieder @joshgray_hcit @strangely_t1 @ruthcarlosmd  

I had a different type of experience in feedback after my diagnosis with RA. When my symptoms improved I noticed a small ad in a newspaper looking for part-time mystery shoppers. I answered the ad and a meeting was set up by the coordinator at a restaurant near me. Despite being somewhat dubious I accepted the job.

It was purely corporate information gathering for the purpose of quality control at a distance. I felt sneaky, like a gumshoe doing a job, but in an underhanded way.  At least the experience in critical evaluation and customer service was invaluable.

My assignment was to go to certain walk-in medical clinics as a new patient and evaluate all aspects of the experience. These included the signage and accessibility, and the staff from receptionist to doctor. The thought of evaluating doctors was totally new to me, and a little daunting. I was not sure it would be easy to critique authority.

In the Canadian health care system my Health Card would normally enable me to walk in, show the card and see the doctor. This job though was being done for a corporation doing market research so I needed a story that let me pay cash for the visit.

I said I had recently moved from Quebec to Ontario and had no Ontario Health card. This way I had to pay.  Letting Ontario tax dollars pay for my "care" would have been fraudulent.

Part of the job was phoning each clinic from a list I was given and asking questions. I felt sure some of the receptionists were able to tell I was a designated shopper.  One was rude and silly on the phone and I understand he was subsequently replaced.

I would love to give useful feedback about many of the healthcare facilities I see now. Cleanliness, signage, friendliness,efficiency and neatness were among the areas rated in that past job. The compliments would probably outweigh the complaints but I see things that could easily be improved.

Some of the doctors were outstanding.  Those who impressed me most showed interest by asking more questions. They involved me in my story instead of taking it at face value and sending me away with a prescription. The good ones seemed to want me to leave with more knowledge than I had at the start of the appointment

RA was a convenient reason for seeing the doctors. I told one I was taking 9 aspirin per day. He told me he personally would always take coated aspirins to protect his stomach. 

 with ring splints

Another time I told the doctor I was depressed because I had actually felt that way after my diagnosis. That did not work so well. Even though the story hung together the doctor commented that I was smiling more than he would expect to see in a depressed patient. He was right. I was having fun doing the mystery shopping because I found it so interesting at the time. 

Now the chain of clinics is gone but it left behind an interesting memory for me.

Better Results With Team Treatment

When I was first diagnosed with RA I was lucky to be presented with a first class care team.  That happened in 1982 when starting a a stronger and more effective drug with worrisome side effects was far less common than now.  These days, when specialist doctors are so busy, you usually have to find the other team members on your own.

In the 80's many doctors still used the old treatment pyramid.

                                       Encyclopedia Britannica

The bottom step of the pyramid (behind the camels) consisted of Aspirin and you had to go through all of the less useful drugs to get to the top and graduate to an immune suppressant drug or DMARD like gold or methotrexate.  This meant that by the time you were prescribed an effective drug, you already had joint damage. This approach is now obsolete.

Now with (ideal situation) early aggressive treatment most of the people I see in rheumatology clinic waiting rooms look quite healthy.

                                       thecanadianencyclopedia.com

Maybe not as healthy as the Canadian women's winning hockey team shown above but now, when I am at a rheumatology appointment I look around and wonder if the people I see are patients or healthy friends who are waiting for patients.

Back to the First Class Care Team

In 1982 when you started on a "dangerous" drug for a serious illness like RA you were often admitted  to a hospital, as much for the education as for the monitoring, and that is where I met the team of health care professionals who have done so much to keep me going, even as they changed over the years. Future posts will go into more detail on the various types of help I received.

The physiotherapist stressed exercise and also introduced me to paraffin wax baths for the hands. She acted like a cheerleader some of the time and helped with hope and optimism.  The occupational therapist told me about resting splints and wrist braces to help with the pain, and introduced me to devices for help turning keys and knobs and opening doors, and also for help in the kitchen.  

A right angled knife is my #1 kitchen device

The pharmacist talked to me about the new drug regimen and precautions to take. I was sent to a foot clinic where I got orthotics to help with my sore feet.  Without orthotics I limp, so I always wear shoes. I met a social worker for advice on how to proceed with work and life.   

Later I realized that a nutritionist would be a big help also and she solved a problem that I had even before I developed RA.

                                               indulgy.com
It's wise to find an excellent dentist and a dental hygienist you can trust. Having a long term consistent relationship means they will spot changes you might not be aware of, and they'll spot signs of Sjogren's Syndrome early. In fact there is a suspected link between rheumatoid arthritis and periodontal disease.


You're the one who owns the chronic illness, so you'll want to be on the lookout for good professionals to help you deal with it.  If that is not affordable there are websites where you can get specific advice and tips that are general.  I'd suggest using the advice and tips you can get from the self management courses to find resources. The official sites of the organizations that deal with problems you have are also learning areas. I'm thinking of The Arthritis Society ,the National Institute of Health ,the Sjogren's Syndrome Foundation and the Sjogrens Society of Canada to name only a few possibilities.

They're not all like Dr. Kildare

Of course your doctor will have a starring role on the team and may have good suggestions for other health professionals and resources that will be useful to you.  You can't just leave it all in his hands though - you need to be as proactive as you can manage to be and work on educating yourself about your health.
                               
You have to be the captain (or co-captain) of the team and also assemble them, with help and advice. It's great to count some family and friends as team members, but watch out for the negative ones, or those who say you should just get out more to feel better. 

I would also like to mention the support of online groups and forums as well as Twitter as a potential big help. If you pick the right support group you may make friends for life, and they know exactly what you're talking about when you are having trouble dealing with symptoms.

                            Friends hanging out near the hospital