“As You Wish” – Wise Words for The Princess Bride and Health Care

One of our family’s favorite movies was “The Princess Bride”. This fantasy/adventure/comedy/morality/love story includes castles, giants, swordfights and pirates. When two young lovers are reunited, they are faced with deception, confusion, and an epic swordfight ensues. Whenever the female lead makes a request of the male lead, his standard reply is “As you wish” as he carries out the task, no matter how mundane. So what does that have to do with healthcare?

I could draw the comparisons between the battles that we fight every day and the ones in the movies, or the struggles we have with the giant issues that confront us. Instead, I’d like to concentrate on “As you wish,” and how it relates to devotion.

In this world of growing commercialization of healthcare, our patients still want to know if we are devoted to them. To face the challenges of decreasing reimbursement, our business emphasis has been to standardize, eliminate, and consolidate. While there are many studies that show that standardization of clinical practices reduces errors, we still should keep the patient in mind as we are doing it. There are also studies that show improved communication with the patient will reduce anxiety, misunderstanding, and even malpractice claims. What would they “wish” us to do as we design our forms, procedures and processes? My wife is going to see a new physician specialist soon. His office sent a packet of information to be filled out. In the multi-page document, there were at least three instances where the same information was requested. My suspicion is that the packet was developed over time and as it evolved, new pages were added without much thought being given to what was already present and expected from the patient.

Another example happened during my hospital administration career. The cardiac surgery team had prepared a folder for post-op surgical patients with extensive information about follow-up. They then got feedback that showed less than stellar scores in patient education. Their response was to increase the amount of information in the folder, and then watched in dismay as the scores went down further. They then took the initiative of actually talking to some patients and families to find out what they wished to be included in the packet. Based upon the feedback, they:

  • Reduced the quantity of information
  • Streamlined its presentation
  • Provided opportunities for patients and families to ask questions

As a result, patient satisfaction scores for education increased.

When someone asks me why we have so much variation in healthcare outcomes, especially compared to a manufacturing enterprise, I like to remind them that, unlike manufacturing, none of our “raw materials” are standard. While there may be some demographic similarities, each patient is nevertheless unique in some way. I am not suggesting that we reinvent the wheel or customize the processes for each patient. What I am suggesting is that as we design our information requests, clinical processes and office procedures that we do keep the patient in mind, and not always design them for our convenience. Instead let’s take the time to think about these things from the patient perspectives, so that sometimes we will be able to answer, “As you wish.”