Isn't it amazing that 28 years later, not much (if anything) has changed in this part of the medical world?

If only as health care communicators we had the option of influencing actual patient care. With 15 years in the industry, it took me far too long to realize that when the public has complaints (usually valid), we are often the first to hear about it, but among the last to have any persuasion in protocol.

Too many times I experienced marketing a bad product –forced to do so against my better judgment.

Even if the services offered were unique compared to our competitors, the negative experience turned each new patient into an activist against our hospital overall – including those that were stellar.

If you go into cardiac arrest, and you are brought back to life with a crash cart, I'm sure you will then appreciate the fact that the robes they give you allowed the doctors and nurses to have easy access.
As for wheelchairs, something to do with insurance. Never, ever have I been able to walk out of a hospital, even after giving birth when I easily walked around after a couple of hours.
I have never had a nurse or doctor call me by my first name unless I was asked specifically if it were OK.
Waiting is a pain. If I have to wait more than an hour, I walk out. I once waited 45 minutes at my doctor's office for blood to be drawn. Then they didn't do one test my doctor had asked for. They called me and told me to come back and have it done again. I said to them "You made a mistake and you want me to be inconvenieced? I was an hour late for work, and now you want me to lose time again because of your mistake? I told the person drawing the blood that the doctor wanted a level done of the script I was taking. It was in the chart too. If your people are so incompetetent, maybe you should hire new ones."
On the flip side, many times people don't show up for appointments. Imagine how long you would have to wait if things were set up for the convenience of the patients and not the doctors?
You should be glad you have insurance. Imagine what your complaints would be if you were one of the 82 million people without health insurance. Sorry, but you don't get much sympathy from me, but I hope you feel better.
BTW, I don't work for any medical organization and never have. I just know from many visits to the ER, it ain't like what happens on "House."

I do work for a health care quality improvement organization, although not all doctors consider us friends.

Good points in this article but what bothers me more is that many doctors don't take the time or effort to talk on a patient's level. Maybe some of them have forgotten how.

About waiting I hate to wait as much as anyone. I have a f/t job, a 3-year-old and plenty of things I could be doing. But when I get in there, I want the doctor to take her time with me (yes, my doctor is a woman), and not rush me out because my 15 or 30 minute appointment is over. That means she's got to do the same thing for other people, which means she's going to be off schedule a lot of the time. I'd rather wait and get the care and time that I need. To me, this is the LEAST of the problems with our health care system. Medical errors are among the worst, and aren't likely to be prevented by rushing the doctors or other professionals. Many errors are CAUSED that way.

Expect it to get worse before it gets better, folks. ERs and hospitals are overworked, and some of the most important jobs in the health care system are underpaid and undervalued. That's not likely to change soon.

Besides the point about asking the doctor to slow down and explain for the patient to understand, I have to say that I disagree with everything Mr. Ragan said. Yes, waiting sucks, but I'd rather wait than force the doctor to leave a seriously ill patient or, worse, her own child just to run a 3-minute test on me. Why should my time be more valuable than everyone else's? And the point about calling a patient Mr./Mrs./Miss and last name, I understand that it's a courtesy, but seriously, does it really matter? What a charmed life you lead if that is one of the main complaints about the U.S. health system.
Though I do agree that the doctors should take the time to explain and answer questions, you can't pin it solely on the doctor. It is just as much the patient's repsonsbility to understand what is going on and speak up if they don't understand. And if the doctor refuses, then find a different doctor.
By the way, what's up with Ragan running old articles? Not that they don't strike up a conversation just as good as new articles, but I've noticed that trend as of late and was curious.

Hmmm... The doctor should not keep me waiting, but should see me quickly, then take the time to speak at length with me, even if it means keeping the other patients waiting. We can't have it both ways.

I like the name point. Mrs. Smith or Mr. Jones shows a level of respect, unless one asks you to use their first name.

I have also been to medical institutions where waiting was much less of an issue. I agree that taking proper time with a patient is more important than having to wait a few minutes, but a balance is important. Ensuring proper staffing helps.

Robes are not a big concern. Proper and timely administering of medications is a much bigger issue. There must be a best practice out there somewhere. But it seems to be a problem at many medical institutions, at least by my experience.

One other practice that I would like to see consistently implemented is a method for patients to recognize doctors and staff who provide better than average care. Rewarding this type of behavior can go a long way. And more than a pat-on-the-back. Something of subtance is deserved by someone who consistently makes patients feel respected, important and cared for.

Larry Ragan was a wise and decent man and a keen observer of our profession. One of the recurring themes of his opinion pieces was how much about the practice of employee communication (apart from the technology) simply doesn't change from one generation of practitioners to the next. And guess what? Years after Larry's departure, communicators are still struggling with the same issues: e.g., gaining "a place at the table," striking the balance between business content and lighter fare, gaining audience trust, generating response, proving one's worth, craft vs. strategy, keeping it real. And on and on.

I say, for those too young to have read Larry's stuff when first published, his heirs are doing you a favor by providing a second chance. It's a useful perspective to realize that the professional problems that so occupy us today have at least 50 years of modern history. And some of the best answers have already been discovered, needing only modest updates to work for us again.

Hmm, it's interesting to see the perspectives here. Some people think medicine is a service sector and should be responsive to the marketplace (i.e. patients/consumers). Others think we should all feel darn lucky to get any attention or care at all. The latter probably would be happy with the "Medicare for all" solution to the health care system's woes - after all, the government is known for it's generous public programs and friendly customer service (IRS, anyone?). I think consumer/patients should insist on better service/value for our health care dollar, especially considering that (1) half of medical care delivered does not meet set standards of care and (2) is not substantiated by outcomes or other research data and (3) it takes 17 years for new knowledge to get into regular clinical usage. Look it up at the IOM website and Dartmout Atlas of Health Care. On the other hand, I think we should start paying more people to go to med school so they don't have to cram patients and pick specialties to pay off six-figure student loans, and to better allocate them to meet the actual needs, not the economic necessities.

Here is some advice for Patients: Know how to defend yourself during a hospital stay: http://adventuresincardiology.wordpress.com/

Not until the Patient is given the legal right to determine how long he wishes to live, and the method he chooses to die will we come anywhere near solving this dilemma, which really cannot be completely solved. A decent, dignified, death is a right of every person in a free society. Our society is an insane asylum run by lunatics in white, who have a vested interest in keeping people alive to suffer and paypeople who want to leave this lousy world, are suffering terribly, and would be much better off in another realm, perhaps one run by intelligent beings. That leaves this nuthouse and its keepers out, doesn't it? Kevorkian was right, those who trashed him are purveyors of pain, suffering, and profit for the whitecoats. Let us the patients decide how long we live, how we leave, and anything else that directly concerns our quality of life. After all, it is our damn lives, not theirs. Will any of this ever happen? Don't hold your breath. Or, perhaps, DO!

In Germany, some years back when I trained there (meanwhile, the American johnny has arrived there!), we saw each patient just in their slip - and that we pulled down too.

Americans feel it is their birthright to be prudish about their naked body (and I guess it is), but as a physician I always wonder how many curved spines and bad skin cancers I missed under those johnnies.

So, I would not redesign the johnny - I would get rid of it. A simple sheet could be used by all who have the wish to cover up - with the understanding that at one point it has to come off.

And Mr. Ragan's other points - they are truer than ever. With one exception: The first name. I got used to my patients calling me "Honey!" (and now I even feel honored). Calling somebody by their first name might be an act of love. At least that seems how Americans have voted - the first name will stay.

You can have it both ways if hospitals aren't understaffed and aren't swamped with insurance claim denials, then they can both take time with patients and not keep patients waiting for hours. Electronic medical records and health insurance reform would cut costs and free up money to devote to staff positions.

hospital care tends to be standardised now like every thing else in an attempt to epedite servise minimizing human contact and humanity as well as dignity and making more acute and severe the wounds of any hospitalization.

I value my dignity and time every bit as much as my health and longevity. Perhaps one of the problems in modern life is that too many accept being treated as a disease or condition rather than a human being. I would prefer to be respected than be healed, if those are my only choices. There are worse things than death.

My dentist, right out of college, "Calls me 'Buddy.' " As in: "How's the tooth, buddy?" I'm 60. She's 26. I tell her I have "an inconvenient tooth." She laughs. So it works.

A Doctor on a break on Call:
All comments in Larry's article 100% accurate.

What to do? Probably start with drastically changing medical training to focus on the patient as opposed to on 'the disease' or 'the test' or 'the medicine'.

Unfortunately, while the twentieth century saw an exponential growth in medical knowledge, it also saw probably the greatest distancing of the medical profession from it's ancient and primary objective: the human being in need.

You pay to lawyer direct. Your doctor is not paid directly. That's is part of the problem. I think the gown issue has been resolved. I call my patients by their first names because at times it is a gentiler thing to do, sometimes. Let me judge that. Foget about patients not using wheelchairs. How about patient losing wight and following a diet when they get out. For one thing the patient may look like they can walk, but if the come in with fainting and their medication is not adjusted, the can fall and hit the head. That is called a centinal event and lots of paper work will need to be filled out. Patient's turn off your cell phones and don't have the person you came with go up and down the hallways of the office, gripping on the phone.

OK next, patients (and nurses) quit calling for sleeping pills. You are all ready on pain pill and other sedatives.

Patients keep you outpatient dr appointments. It will keep you out of the hospital. Oh and I forgot to tell you that your dr is required by law to treat patient who can't or will not pay.

Regarding the use of first names: If you ask for copies of your progress notes, more than likely you'll see that your doctor refers to you as "Ms." or "Mr." when dictating, even though they feel it's okay to call you by your first name in the office. I guess when it's it print, doctors require a higher level of professionalism. Try calling your doctor by his or her first name - You'll likely see an expression of shock, or evidence that they are offended. How many doctors introduce themselves to new patients by their first names without the word "Doctor" in front of the name? Doctors, it seems to me, believe they are more important people than patients - better, smarter, healthier, more talented, etc. How dare you lowly patient call the doctor by his or her first name... how dare you disrespect his or her social and professional standing. I think its time that providers get over themselves and realize that they are just people - just like their patients. And by the way, aren't patients the reason these people have roofs over their heads?

The health care system in the US has been wildly out of control for decades. These are but a few of its offenses ... real and symbolic. Countless groups are to blame. But the prime culprits are doctors and patients who do not organize to change the system.

This article brings up another point: the patient needs to be proactive. The doctors these days seem to be in a hurry - they don't seem to spend much time with patients. However, if the patient educates himself about his own condition, and this self education is much easier nowadays because of the Internet - the doctor will be obliged to engage more with the patient and answer his questions and concerns more carefully. As an example, in my own case, my cardiologist was not aware of the beneficial effects of flaxseed meal in lowering cholesterol. When he saw the results, he was pleasantly surprised and accepted the use of flaxseed as a nutritional supplement for lowering cholesterol in addition to the standard treatment using statins.

Having had several major surgeries in my 70+ years, I can't really complain about my care in hospitals. I do object to the 19 year old graduate of the local shopping mall "medical" school calling me by my first name the first time she sees me. I'm a relatively small person, so the "robes" don't bother me. The wheelchair exit is fun, usually one of my sons push me in it. Waiting 2 hours to see a doctor who listens to my chest, feels my ankles to see if they're swollen, peeks in my mouth, and charges $180 for his 10 minutets that bothers me.

Why must we treat Dr's as Gods. They are human beings just like the rest of us. Yet they perform important services, but so do policemen, firemen and many others. They are also businessmen, even if they don't like it. The point is that by keeping you waiting they are simply demonstrating their lack of respect. Because doctors see patients all the time they should have a much better idea what the wait time, on average, will be. As to the utilization of first names, it is not a matter of not being raised correctly, it is a matter of respect (and, frankly, control). My doctor and I are on a first name basis because we discussed the matter and agreed to it. One matter not discussed, is why the computer age still has not arrived in the offices of many doctors? I had a visit to my doctor recently (and was seen by a PA) who failed to see in my file (handwritten notes, etc.) that I had been in the hospital for a week 6 months ago for surgery and had my blood taken and analyzed every day (my doctor had visited me there every day). If the records had been digitized and shared with the hospital, all that information would have been in my records. The medial profession is very important in our lives, but, as far as I can tell, it is still practiced by human beings all of whom should be respectful and working in the modern age. They do not get a pass any more than anyone else.

The waiting issue at the doctors' office could largely be resolved if the corporate heads in charge would quit insisting on scheduling six 20 minute appointments per hour.

The wait at ERs could be greatly reduced if people didn't try using them for primary care.

A few thoughts as a physician. Nationally, 20% of patients fail to show up for appointments. No notice or courtesy phone call. If you work at a hospital or seek the opinion of a practice consultant, they will recommend booking at a 120% of capacity. Unfortunately, this means that if everyone happens to show up on a given day, there will be a delay. Another 10-15% of patients show up 15 minutes late. In my mind this represents an extreme discourtesy to other patients. Show up early for your appointment, and there is a good chance that you will be seen, because the patient scheduled at the top to the hour will be late. Always carry a typed list of your medications in your wallet. Your pharmacist can print up a list. It helps the physician, and if you are in the an accident, it can save your life in the E.R. As for compensation, I can charge any amount as a physician, but if I accept insurance, I am paid a set rate. For example, Aetna and United HealthCare pay about $35 for a 30 minute office visit for an established patient. Try paying office overhead at $70 an hour. The insurance plans in DC have ped re-imbursement by 20% in the last three years, and yet expenses go up. My office overhead is $235 an hour for employee salaries, rent, malpractice etc, before I make an nickel. Unfortunately, many doctors spend 8 minutes with a patient and bill for a more complicated visit. Ethically, this is wrong. However, this is driven by third party insurance companies that charge the patient more for premiums and co-pays while paying the docs less. Ultimately, alot of docs forego insurance and charge for the visit. You have a better chance of seeing those doctors for a longer visit. Finally, all of you out there who call your doctor on weekends and holidays with infections that you've had for a week, who want prescriptions for free (and you know who you are). Those days will be coming to an end because we have to meet our expenses. I graduated med school in 1995 and still have $70,000 in loans to pay off. The days of Marcus Welby are long gone, but he got more for an office visit than I ever will. I also work at a University and provide free care and have been in the OR on holidays fixing trauma patients for free. So' we're not all rich and evil.

I am from the age when patients sat in their underwear to be examined by the doctor, and at the age of 80 now I wish we would go back to it. For one thing it is less fussy to disrobe to that point, and much easier to re-dress. And unless women are determined to wear their sexiest undies, it is every bit as tactful. The only problem with any of the disrobings is being cold, but hey, wear your coat until it has to come off. Modesty in this day and age doesn't seem too relevant. Everyone, get over it!

On the first name thing....

Bottom line up front - use of first name without the correct relationship between the parties can be seen as condescending/insulting, etc (to either party).

If I'm dealing with a child, he/she is Billy or Susie and I'm Dr John.

If I'm dealing with an adult, I introduce myself as Dr Lastname and refer to the patient as Mr/Ms/Miss/Mrs Lastname. (Or Professor, Ms Mayor or whatever might be appropriate for their station.)

When it comes to adult females, I ask them whether they prefer to be called Ms, Miss, or Mrs.

I would never think of calling a patient of my parents' generation by his or her first name (even if he/she asked me to).

I wouldn't expect to have a first name relationship with someone a generation younger than me.

For people around my age, by the time you know your patient well enough for a first name relationship it's time to consider if you are too close to your patient to offer objective medical advice and maybe he/she needs another doctor and you're now just friends.

Anyway, I think it's wrong to call an adult by first name and not expect to get addressed by your first name. Common courtesy.

Dr John

Where are 19 year olds graduating from local "shopping mall" medical schools? Sounds to me like the complaints of a lot of grumpy people who want respect but do not give it. I know my patients well, and they tell me when they have had a frustrating wait, but they understand because they know they will also get the time they need from me. They call me by my title/name, and I do the same with them (a point from another column, I have called patient's mothers "Mommy" and I say this with the utmost respect for that position. After hearing a criticism of that I started asking mom's how they feel about it and they all, like me, find it very respectful-it communicates that while I know the medicine, they know the child, and we are a team) I think most doctors are hard-working people who care about their patients, and are not puffed- up about themselves. And I think most patients are kind and understanding. People that gripe about doctors probably also gripe about plumbers, policemen, waitresses, teachers, humans.........

Several of the comments call for patients to be pro-active when dealing with physicians, but the fundamental flaw in that logic is, at least when you're admitted to a hospital these days, you're very, very sick and usually don't often have the strength to ask the right questions, do the followup and do the research. For older patients, the ability to see, hear or comprehend may be impaired as well. As someone who has just dealt with the longterm illness of an elderly parent, I urge anyone who knows they'll be entering the hospital to have a pro-active advocate who talk with the doctors, nurses, and get in the Internet and help with medical paperwork. It's also good to have a designated advocate in advance for unexpected hospitalizations or dealing with repeated doctor visits, especially if you don't have a partner or a spouse, or if your partner/spouse is not helpful (and a lot of them can't or won't deal with the it.) Dealing with the medical community takes a team effort anymore to be successful.

As a retired R.N. I realize that the background, the education, our society, and the "type" that decides to study medicine, all contribute to this strange mixed-bag of a robot-like creature we call a physician. Generally speaking, they don't like people much - have a high divorce rate and tend to think of folks in terms of the body part that's giving the patient a problem. Remember this, surgeons especially are always edging towards the operating room - they like to be there to "practice" their skills and bring in the cash. Always get more than one opinion before agreeing to a surgical procedure, unless you're at death's door. Google is a wonderful source for researching your medical problem, many times revealing information you weren't told about while slipping down the conveyor belt at the clinic.

So many posts to read - I hope I am not repeating too much of what is already being said. I have worked in a major health care institution as a communicator for 11 years, but we in the PR and MC office have nothing to do with communicating to patients on a day-to-day basis, except when we accidentally get phone calls for patient relations or when we are setting up interviews for the news media. Communicating for and to patients is the job of clinicians and staff working in patient care areas, and of patient relations, none of whom have communications backgrounds in the broader sense of the term. We have no influence on this, unfortunately so. I often find very confusing and difficult-to-read patient education information or porrly written letters and wish all of those items could be edited by us before being posted or published. But, I believe that clinicians would rather not give up control of these messages. They just don't understand how jargon-packed their language is and how easily confused a patient can get, especially when in distress.

Well....coming from a patient perspective who after being healthy and active for most of her adult life I have to agree with many of the opinions expressed above after being a sick person, for the past 4 years. I am still active though it gives me pain. Why, because our bodies were designed to move... SO...yes, lose weight by changing habits and remaining active every other day if not everyday!!
One doctor introduced me to the sheet and it kept me warm until it was time to it....made things a whole lot easier, I love my body and keep it active despite its extra curves. Learn to love your body and get over your prudisness 'cus them "doctors" are not looking...just go to a nude beach sometime and you'll see what I mean. We live in a society where too many EAT,EAT and EAT some more and are NOT active, so don't try lying to your doc 'cus they know!! And if you are one of those, you add to the long lines in the waiting room and add to an already overburdened healthcare service because your doctor is NOT responsible for your health, YOU ARE!! Your doctor is responsible for the illness you present with.
May God, Buddha, Allah, or whomever you praise "Bless doctors!!" I will wait until the end of time in your waiting room because you took the time to study sssooooo hard and help your fellow man/woman. Be good to yourselves and others because you are the best!!

This would most certainly be a patient's paradise, but if the doctor did everything on this list then that would make their job even more miserable. I do agree with a few of the statements like the name calling and the robes but like any profession Doctors need to balance effeciency with quality. Sometimes you need that extra wheelchair and maybe you need to keep that patient waiting a few minutes longer to be efficient and give the best quality care that you can.

Dr. John,

Adult females can be 'mayor', 'professor', 'counselor', 'goddess', 'dr.', whatever - just like those other 'adult patients' you're seeing. I personally have all the credentials in place to respond to both 'professor' and 'dr.' (having a terminal degree in my field, not just a clinical, professional degree like M.D.s). In regard to titles, and as a woman who uses a hyphenated name, nothing irritates me quite as much as being referred to as 'Mrs.' or 'Ms' as well as having my surname ignored in medical records systems. If I'm expected to use a professional title to address a physician, then I expect my professional title to be used too. I personally prefer to interact with others on a first name basis, but don't mind using professional titles if those I'm interacting with prefer. What I won't abide is being talked down to and I won't tolerate being labeled in a subordinate role. A patient is not a subordinate, a patient is a customer buying a service from a business. And while I dearly love and adore my husband, I have managed to accomplish a few things more in life than being marriageable. Further, my LEGAL last name includes the letters that come both BEFORE and after the hyphen. Dr.'s practices are creating inaccurate, incorrect records when they ignore the letters before the hyphen. I'm considering having my name legally changed to not include the hyphen. This will create an absolutely nonsensical word, but at least it will be accurate and administrative recordkeepers won't be able to dismiss my actual identity with such careless disregard.

As for general rudeness in practice: if I can walk, I refuse a wheelchair. Does it irritate a few docs and nurses? Yeah, but, so what? It's an insulting, demeaning practice and there's zero, zilch, zippo reason to indulge it. Again, patients aren't subordinates. Patients are folks paying for advice or treatment that they may or may not choose to accept. It's their right and prerogative. The best thing that could happen to customer service in the medical industry is to banish the term 'compliance' from the profession's lexicon. What a terrible way to think of the folks paying off your student loans, buying your house, and sending your kids to college.

In regard to waiting: I think of medical appointments as the business transaction that they are and I give the medical profession the exact same leeway that I give anyone and everyone else. If it's explained to me promptly and politely that a physician is behind schedule and why, then, if it doesn't conflict with the rest of my schedule, I'm more than happy to patiently wait (no pun intended). I understand that sometimes people get behind in their work (I know I do occasionally), the point is to treat everyone involved in the situation like their time actually has value. If I'm not promptly informed of delays, I give the practice the same courtesy period that I give anyone else I do business with. If they're running more than a half hour behind, I politely excuse myself.

While this may sound slightly hostile, my relationships with my healthcare providers are fine - polite and civilized. I have found it useful to ask for referrals from personal friends who are M.D.s to their colleagues. This type of introduction cuts out a great deal of the officious, high-handed, dismissive behavior. Unfortunately, not everyone has this luxury. So, ethical providers will need to buck the establishment and treat their customer like they would like to be treated themselves (sound familiar: it's a good rule).

The New York Times should publish this in book form for distribution or sale to doctors and other health professionals.