More on health and usability

A acquaintance of mine, a vet, reported today from the “Every Pet, Every Time” UK conference that 70% of human patients have forgotten their doctor’s advice 60 seconds after leaving the consulting room. She commented that doctors and vets have much to learn on communication.

I’m a well-educated, assertive, healthy white woman. I speak English as a first language and some of my freelance work involves medical writing. But I’ve still had some confusing, upsetting and humilating experiences with the medical profession.

There was the time I was hit by a car and taken to A&E. The hospital receptionist tried to turn me away because I was too upset to remember the postcode of the house I’d recently moved into. Then there was the time shortly afterwards when I had a virus combined with heatstroke and NHS Direct told me to go to A&E, but the same receptionist tried to turn me away again because I still couldn’t remember my new postcode. (I was left to lie on a trolley holding a tub full of my own vomit. My husband ended up on the trolley next to me after cycling ten miles to see me in hospital and collapsing with dehydration himself when he arrived. Nobody would give him any water so he ended up getting a can of fizzy drink out of the vending machine and being sick. Ah, so many funny stories from the heatwave of 2003.)

Or we could talk about the time my GP told me to lose weight, then weighed me and found I wasn’t actually overweight according to the BMI scale they use. He was at a loss for what to advise after that, so he suggested losing weight anyway, “as an experiment”. Did he think it likely that it would help with the problem I’d come in for? Probably not, but why not try it? Would it make him more likely to help me with the problem I’d come in for? No, definitely not, but why not try it?

Or what about the time the doctor (a different doctor) called me “hysterical” for complaining of knee pain after being knocked off my bike twice in the space of weeks (and landing on the same knee both times)?

Or we could talk about the time the doctor (yet another doctor) said I didn’t have any tonsils and wouldn’t believe me when I told him I’ve never had my tonsils out. (In the end, he grudgingly looked in my mouth and snapped: “Well, if you HAVE got any tonsils, then they’re pretty small!”)

I’m certain these aggravations are minor compared to what I’d go through if I was trans, if I didn’t speak English as a first language, if I was less assertive, if I wasn’t white. But why does it have to be this way?

I’ve written before about how the NHS should be run with usability in mind:

We’re hearing a lot at the moment about “increasing patient choice” through introducing markets into healthcare. But rather than seeing patients as rational consumers in a free market, I’d prefer to see them as service users in need of more user-friendly services.

I still absolutely stand by this. I’d like to see usability built into the fabric of the NHS. I’d like to see user testing happen as a matter of course. It’s not a waste of resources; it’s a way of conserving them. If 70% of patients really forget their doctor’s advice within a minute of leaving the consulting room, that’s a resource problem and it needs to be tackled. We know that health outcomes depend on patient adherence; so why not test and shape the system into one that makes patients more likely to stick to their treatment plan?

What if one in every thousand GP patients was paid to user-test the system, commenting on the whole experience and then being tested on what advice he or she actually remembered? What if the same thing happened in hospitals with A&E patients, patients staying a week or longer, outpatients visiting for a follow-up appointment?

Some of the things “learned” would be things already obvious to patients:

It’s a consulting room, not an insulting room

Stop fixating on the weight of any patient with a BMI of 24 or more, especially when it’s not relevant. Yes, maybe that broken leg would hurt less if the patient was putting less weight on it, but maybe you should try focusing on getting the broken bone to heal?

Harmful lifestyle choices become even more harmful if fear of humiliation puts the patient off going to the doctor at all. Lots of people have learned to fear and avoid authority because they’re tired of being told off. Sure, have a word with that patient about his smoking, but not in such a way that he feels he can’t visit the doctor about anything until he's given up.

And please, believe me. Why do you think you know better than me how much exercise I do, how much pain I'm in, whether or not I possess tonsils? And what do you think you gain by implying that I'm a liar?

Write it down and explain

I was once visiting a friend in hospital when the doctor mentioned a recent “GI bleed” he’d had. I had to explain to him after she’d left that “GI” was short for “gastro-intestinal” and then explain what “gastro-intestinal” meant. Just saying “GI bleed” was about as useful as talking to him in French.

Writing key words down is really useful for patients who struggle to understand spoken information. Also useful if the word is likely to be completely new to them. Yes, they’ll probably go away and Google it, which is annoying because you’re the doctor and you know best. The question is: would you rather they Google your advice and possibly question it, or forget everything you’ve said within a minute of walking out of the door?

Well-written information leaflets are great, and I’d like to see more of them. But keep the font big enough for everybody to read.

Other things learned through the process would probably be utterly surprising to patients and professionals alike: maybe speaking fast is actually better than speaking slowly, or maybe offering patients a mint puts them in a calmer frame of mind, or maybe the layout of your consulting room matters more than you think.

But this is what we need: a focus on the user experience, on testing and shaping it. But to do that, we first have to save the NHS from being broken up and privatised and shaped towards serving the interests of profit rather than patients. This is why, if I lived in Eastleigh, I’d be voting for the NHA Party tomorrow.