The Real Quality Chasm: Differences in Perceptions Between Doctors & Consumers

I'm writing after seeing my doctor and just being tired of the lack of quality I'm seeing ... and what I've seen when I've been to other doctors as well. 

A few years ago, the prestigious Institute of Medicine (IOM) created quite a stir when it released something called the Quality Chasm Report which indicated a huge gap between best practices and current treatment of many of the nation's most prevalent illnesses.  Depression was, I think, number one or two on the list. This led to a flurry of other papers and conferences—doctors all looked at the problem and agreed that SOMETHING MUST BE DONE. This led to other meetings where people gathered and wrote instructions and guidelines about what should be done.

Lots of conversation. Lots of writing. But not much actually implemented yet.

While I was an active participant in many of those meetings and still hold hope that they'll make a difference in the future, I think the real quality chasm is very different and is something to be wrestled with before any changes can occur within our system. I think the real chasm is the difference between how doctors perceive their care/treatment and how their patients perceive it.

I was recently asked to speak to a very prestigious groups of individuals who were examining quality measures. I shared with them the following survey results that indicate what consumers want from doctors:

According to one survey we did with over 2,000 people responding, our number one request of our doctors was this: "Give me hope; make me feel hopeful about my future." This response was confirmed by another meeting attendee, a doctor who has made a name for himself in quality measurement in mental health. He said that while no one's able to quantify this yet, providing hope will not "go away" as a key indicator of what we consumers consider quality.

Other things we want from our doctors in a quality practice?

• Let me make decisions and have some input into my treatment/care.
• Focus on my wellness, not my illness.
• Act in a way that shows you believe that I can recover.
• Listen to what I need instead of telling me what I need.

Notice that we didn't say we wanted doctors who had more degrees or board certifications, cleaner offices, better office hours or a fax machine. We wanted hope, empowerment, recovery orientation and responsiveness.

In another survey DBSA did with NAMI, we asked what the hallmarks of a good professional were. There were about 900 people who responded. What did we most want? "Please listen to me," was the number one response. Did you know studies show that a consumer will speak for less than 20 seconds before a doctor will interrupt them?

What else did we want?

• Communicate with me (i.e., speak in ways I can understand).
• Be compassionate.
• Be knowledgeable.
• Have decent interpersonal skills.

Notice that only one thing on both lists I've shared so far is taught in medical school.