So I had my first appointment with yet another doctor today, one of the side effects of moving twice within 4 years. I really liked her--she's very cool in a nerdy way and I wonder if outside of the sterility, we might have a lot in common. I didn't get a chance to tell her I loved her sweater.
But the whole experience left me feeling like there must be a better way to conduct this transaction, which should be very intimate and humanizing, but is all too often impersonal and dehumanizing. The patient is definitely viewed primarily as a consumer--the first thing you do is pay your co-pay, then fill out forms related to information and billing. You sit in one of many uniformly arranged chairs in a flourescently lit windowless room. Even the plastic clipboard I had to fill out forms on was sponsored by Adderall with a little brain clip for the pen. I don't even know what Adderall does, but it must have something to do with a blue plastic brain. Then you are ushered into a room and treated with as much detached, disposable distance as possible. I was instructed to sit on the crunchy paper covered table (instead of on the nurse's level in one of the chairs) while answering questions about personal medical history. The thermometer I held under my tongue was a disposable piece of cardboard--smart cardboard, but still disposable. Nowhere to put my clothing except on one of the molded plastic chairs. The discreet "outfit" I had to put on was made of bleached paper (not to mention the layout of the room was such that my bum was exposed to the door even with the "sheet" over my lap). And the covers for the stirrups? Proudly sponsored by Somedrugcompany.
Perhaps I would be the unusual outlier on a consumer preference survey. Perhaps most people prefer as much anonymity and sterility (of all kinds) as possible when they go to the doctor, but I don't think I'm too strange in my desire for more holistic care. I'll keep looking for that rare doctor who's rebelled against the system aesthetically and economically, but in the meantime, it seems like doctors and groups within the sytem could make a few changes that would subtly alter the patient's experience and downplay the consumer identity.
- Intentionally craft the waiting room, one in which you'd feel comfortable watching a movie after office hours. Put meaningful, original art on the walls. Create conversation spaces, even if people don't converse. Use natural and incandescent light wherever possible.
- Give the receptionist an open desk instead of a little window cluttered with garishly colored competing signs about fees and co-pays and insturance. Post one simple sheet with current notices.
- Politely decline the pens, clipboards, stirrup covers, travel clocks and other branded promotional items offered by door-to-door pharmaceutical sales people. It's not only insulting to patients, it's insulting to doctors as well to be treated as consumers and marketers in their own workplaces. If there's any advertising in the space, make it for local parks, organizations, restaurants and businesses that will contribute to a patient's overall health before he or she needs a prescription medication.
- Have a small wardrobe in the examination room where patients can store their clothing during an exam. More original art here, too--themes of healing and wholeness and the joy of physicality. Put up the doctor's bio and interests for patients to read while they wait. Use skylights to get natural light into the room. Communicate warmth and relaxation with colors and sounds and light, rather than cool sterility.
- Use sterile, but re-usable products when possible--a cotton gown, a real thermometer, etc. Surround patients as much as possible with materials that have some kind of natural integrity: cotton, wood, glass, metal, as opposed to plastic, plastic, plastic.
- Building from the ground up? Emphasize green features that express care for the environment that, in turn, has an effect on our personal physical health. Build on a bike path and have bike racks outside. Build in a walkable area of a town or city.
Any other suggestions?
I looked up Adderall, by the way. It's for ADHD. Go figure.
Great suggestions, Kirstin.
While I don't like the old sterile looking clinic waiting room, I am also not too fond of the recent rush to the Pottery Barn/Martha Stewartville living room look undoubtedly being promoted by the armies of doctor's office design consutants. Though more comfortable, it just seems contrived and fake to me.
I would like to see the ubiquitous television eliminated. There seems to be no escaping it. Instead, why not some soothing background music (real, not Muzak)? Redicare clinics are even worse with the Matrix-like video game station which mainly serves to pass germs amongst all children visiting the doctor and unnerve those that seek a little quiet while waiting with their ailments.
The other suggestion might be a small health library. One could peruse books on different subjects,and maybe even check them out.
Thanks for the additions to the list, Jeff--especially the library! What a great idea to make the office a center for more than just 'appointments', but for people's ongoing efforts to live well and be truly healthy.
You're right--a comfortable waiting room can be contrived if its origins are in professional consulting, the goal of which isn't ultimately care for the whole person, but care for the bottom line.
Wow. these are great suggestions. In the office where I work (as a family physician) we do some of these things - cotton gowns, real thermometers, natural lighting. But other things are great ideas. I especially love the original art ideas, and making the reception area less clinical and more open. It's good to know, too, that patients dislike all the pharmaceutical crap. I also dislike it, and try not to use anything with the exception of pens, mostly just because I go through a lot of pens writing and I tend to lose them, so it's nice to have free ones around. But I definitely do not want my patients thinking that I'm somehow in the pocket of the drug companies, especially since I rarely prescribe name brand products and try to stick to the Walmart $4 list. The ideas about walking tracks would also be great for physicians who often don't have enough time to get the exercise we need, so having a place to walk/run/bike where we work would be great! I'll definitely try to remember this list when I finish residency and either join a practice or start a new one. Great post!
Thank you so much for your comment, Aubrey. It's really refreshing to hear encouragement from someone who can actually make a difference in the field. Best of luck to you!
Incidentally, I have to schedule my next check up soon and, having ditched our pathetic health insurance, I think I'm going to try a local preventative health care clinic that practices osteopathic medicine. That will be a new experience for me and I'll have to post again about that experience and whether it's any different.