It's a sad commentary on the status of medicine when physicians are being compared to baristas. But when our patients have a less than 30% real literacy rate, we need ask them more than "regular or decaf?"
My ears perked up on a recent morning as I listened to NPR Marketplace. There was a short blurb about Starbucks baristas being better able to explain to a customer the problem with their coffee than a physician is at explaining to patients the nature of their problems.
For the most part (with few exceptions) baristas — however Starbucks may choose to educate them — throw away their bad beverage results. We have no such luxury. Our patients come to us, not with a menu of problems, but with problems in place, including their culture, language, bad habits, poor maintenance, education and social ills. For the most part they expect US to fix THEM — not their drink. Although there is a move to transfer some responsibility to the patients, I see it as a slowly evolving process.
When our patients have a less than 30% real literacy rate, we need to ask them more than “regular or decaf?” When they come with uncontrolled hypertension and diabetes, more than “which flavor pleases you?” Overall, I resented the tone of the piece. We put in, as my son oft says, “years of evil medical school,” followed by years of re-learning re-educating, re-training, mentoring and being mentored, and still we have “doubt.” I doubt that the barsita education prepares them for more than pulling the handle and “thank you.”
Administrators have long taken the tack that we, the providers (how I HATE that word), are units which can conform to the classic marketplace systems. AIDET: Acknowledge Introduce Duration Explanation ThankYou. We are constantly pressed to do more with fewer hours, see more patients, provide more services, educate the patients more thoroughly with an increasingly clipped time to push more units through the system.
I do hope we don’t come to classifying our patients as Grande/Venti/Trenta. It’s a sad commentary on the status of medicine when we compete with baristas.
Dr. Buchbinder is a board-certified Podiatrist practicing within an FQHC (Federally Qualified Health Center) in Hartford, CT. He is director of the FreeMED Software Foundation, a nonprofit dedicated to making accessible and extensible medical records available worldwide. Dr. Buchbinder also blogs at A view from the provinces: A new Yankee’s view of the world.
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Alabama Med Student here….tomorrow we will be implementing the Grande/Venti/Trenta patient classification system on our internal med clerkship. Starting at Grande is quite appropriate in this case (as opposed to sizing at Starbucks).
I find myself both agreeing and disagreeing with you, Dr Buchbinder. True, the tone of the NPR piece was a bit trite and overly simplified (no doubt tailored to its audience, despite NPR listeners’ higher than average level of education). However, there is a point to be made from this short discussion. No, I do not believe that physicians (or mid-levels like myself) should be compared to baristas. Yes, I do believe it is our responsibility to understand the limitations in communication that are inherent in the populations we serve, and do these good folks right by tailoring our patient education to their level. By doing this, we can accomplish two things: increase patient compliance and understanding, and develop a stronger rapport and level of trust between patient and “provider”. I can understand that, serving at an FQHC, you very likely see a higher proportion of patients with lower literacy, and this can be frustrating. On the other hand, and with all due respect, catering to their level of need is the job of a provider no matter the circumstances.
You’re a mid-level provider? Do you provide mid-level care?
Typically, in talking with physicians, NPs and PAs are described as “mid-level”, owing to the shorter extent of our clinical training. That’s why I chose to use it here in a physician-oriented forum. However, I work in a state where my prescriptive privilege is completely unrestrained, and no collaborative agreements are required. I operate completely independently, and thus, I would say that I serve my patients as more than what one might consider “mid-level”; rather, I operate as a comprehensive, “full-level” provider.
With the whole patient compliance idea, has any one thought “maybe there are a lot more people out there that do not want to get better and are just pressured socially into seeing a clinician”?
It is sad to say but there many times in a week when I feel like saying “Would you like French fries with that?”