Investigating the Doctor Appointment Experience
While we had selected a problem area given to us by our sponsor, my team knew virtually nothing about the space save for what we knew as patients ourselves. We set about conducting both secondary and primary research to better understand what the current state of the doctor's appointment experience was for patients of varying backgrounds and health journeys.
Patients with Chronic Conditions
Patients with No Chronic Conditions
Something that became clear to me early one was that sentiment varied greatly between patients who suffered from chronic conditions vs patients who did not.
Patients with chronic conditions had much more polarizing sentiments on their healthcare experience. In order to investigate this, I talked to patients with chronic conditions about their healthcare journey.
Patients with chronic conditions had much more polarizing sentiments on their healthcare experience. In order to investigate this, I talked to patients with chronic conditions about their healthcare journey.
Insights From Talking to Patients With Chronic Conditions
1
Telehealth Skepticism
“There have definitely been instances where, during the pandemic, I only had the option to be virtual. And that was really challenging, because there were symptoms that I felt required actual examination, right? ...They literally told me ‘take your phone and can you shine it in your mouth. So we can see?’ You're not gonna get as accurate as an in-person appointment.”
— Research Participant
— Research Participant
What Does This Mean?
Telehealth was not as preferred as we thought, especially by those who frequent the doctor the most. They remained distrustful of a doctor’s ability to correctly diagnose and prescribe. One of our interviewees told us that they were constantly under-dosed when prescribed medication via telehealth, something they hypothesize is ironically also due to the doctor’s distrust of telehealth as well.
Telehealth was not as preferred as we thought, especially by those who frequent the doctor the most. They remained distrustful of a doctor’s ability to correctly diagnose and prescribe. One of our interviewees told us that they were constantly under-dosed when prescribed medication via telehealth, something they hypothesize is ironically also due to the doctor’s distrust of telehealth as well.
2
It’s a Fulltime Job
“I had to steer my own ship. I kept a long Google Doc of all my symptoms, treatments, medications, recommendations, and I would pull it up whenever I went to see a doctor.”
— Research Participant
— Research Participant
What Does This Mean?
Health management and consequently check-in can be exhausting and take a lot of time. The burden is really on the patient to document and actively manage. This becomes infinitely trickier if you are suffering from certain long-term conditions which require specialist care and multiple doctors.
Health management and consequently check-in can be exhausting and take a lot of time. The burden is really on the patient to document and actively manage. This becomes infinitely trickier if you are suffering from certain long-term conditions which require specialist care and multiple doctors.
3
It Takes a Team
“I see 3 or 4 doctors regularly.”“My main doctor is my integrated medicine doctor, but I also have a PCP, a neurologist I was seeing for awhile, and a couple others.”
— Research Participant
— Research Participant
What Does This Mean?
Our participants who required more closely monitored care or suffered from specific chronic conditions had multiple doctors they saw regularly. Oftentimes, their main doctor was not their primary care physician but a specialist who has more knowledge on their specific condition.
Our participants who required more closely monitored care or suffered from specific chronic conditions had multiple doctors they saw regularly. Oftentimes, their main doctor was not their primary care physician but a specialist who has more knowledge on their specific condition.
Why is the System Failing Patients with Chronic Conditions?
We now knew intimately how thoroughly the current American healthcare system was failing patients dealing with chronic conditions.
But, what did people working in the system think? What systemic problems exist that place so much of the burden of care on patients dealing with their chronic conditions?
I talked to a group of healthcare subject matter experts to figure out what was happening on a larger scale in healthcare.
But, what did people working in the system think? What systemic problems exist that place so much of the burden of care on patients dealing with their chronic conditions?
I talked to a group of healthcare subject matter experts to figure out what was happening on a larger scale in healthcare.
Insights From Talking to Subject Matter Experts in Healthcare
Acute vs Chronic
What Subject Matter Experts Said
The current healthcare system model is not designed for chronic conditions, rather it takes an “episodic” approach - come in, get treated, then come back when something crops up.
The current healthcare system model is not designed for chronic conditions, rather it takes an “episodic” approach - come in, get treated, then come back when something crops up.
The first big distinction I made through talking to subject matter experts was realizing that check-in could potentially be very different depending on whether or not you have an acute or chronic condition.
Industry Trend Towards Unity
What Subject Matter Experts Said
The healthcare industry is starting to move towards integration and unification across systems. A big barrier to this is lack of market incentive.
The healthcare industry is starting to move towards integration and unification across systems. A big barrier to this is lack of market incentive.
With the way healthcare is structured in the United States, there isn’t really incentive for hospitals to share information with each other as that means potentially losing “customers” or patients.
Disruption vs Optimization
What Subject Matter Experts Said
A better appointment process may mean completely bypassing or rethinking the entire current experience. Other areas may benefit more from incremental optimization.
A better appointment process may mean completely bypassing or rethinking the entire current experience. Other areas may benefit more from incremental optimization.
Market solutions my team looked at earlier on showed a lot of innovation happening around making the wait time at doctor's offices more bearable. However, are there cases where check-in and consequently wait time can be completely removed from the equation?
How Do Doctors Feel?
The last piece of my research consisted of talking to doctors to figure out how they navigated patient care.
Observation
Doctor’s have too many tasks and too little time. These have only increased with modern healthcare technologies which make the amount of patient information captured much more robust but require doctors to maintain and update this information.
Design Implication
Consolidate communication + information channels that a doctor and patient must manage.
Observation
Doctors aren’t always compensated for the extra work they do to care for patients. For example, doctors have many tasks outside of just seeing the patient. They also need to read through patient files, work on health recommendations, and input information into a patient's file. These are all things doctors must do that they may not be paid for if it is outside of a patient's appointment time.
Design Implication
If we can’t decrease the tasks, we need to make it easier for patients to manage extraneous tasks and communicate this to doctors.
Observation
Newer technology has enabled faster, more dynamic communication but can sometimes be a friction point during appointments. Relating to the first and second observation, doctors may feel pressure to try and input information during the appointment time to make sure they're getting compensated for their work and to make sure they aren't missing anything the patient has mentioned.
Design Implication
Make health info easier to access and navigate across appointments.
Information is a Double-Edged Sword
A common theme arose from talking to the patients and providers.
Patients were overwhelmed trying to keep track of all their health information, this was made worse for patients with chronic conditions who must go to the doctor more frequently (which means more doctor's notes, more medications, and treatment plans) and across multiple doctors.
Providers talked about how modernized digital EMR systems allowed them to input more information about their patients during their appointment. Unfortunately, this meant that doctors had more and more tasks relating to information maintenance. These tasks were things they were not compensated for as they did not directly relate to the care of the patient.
From here, I saw a more specific problem my team could tackle: the modernizing of healthcare record systems has led to a collective inability to manage all of the information in a meaningful and effective way.
Patients were overwhelmed trying to keep track of all their health information, this was made worse for patients with chronic conditions who must go to the doctor more frequently (which means more doctor's notes, more medications, and treatment plans) and across multiple doctors.
Providers talked about how modernized digital EMR systems allowed them to input more information about their patients during their appointment. Unfortunately, this meant that doctors had more and more tasks relating to information maintenance. These tasks were things they were not compensated for as they did not directly relate to the care of the patient.
From here, I saw a more specific problem my team could tackle: the modernizing of healthcare record systems has led to a collective inability to manage all of the information in a meaningful and effective way.
