Demystifying Medicine One Month at a Time

Tag: patient experience

Tradition Royale

In the spirit of all the hoopla over the wedding of Prince William and Kate Middleton, I thought it might be time to demystify certain letters you’ll often see after a doctor’s name on a business card. The custom of letters representing “fellowship” in medical societies is English, after all, and dates back more than five centuries.

FRCP: This implies that the doctor is a “Fellow of the Royal College of Physicians.” Fellowship in all of these societies is an


Royal Wave

honorific, reflecting good standing in the profession and a degree of professional accomplishment. The Royal Colleges (Physicans, and Surgeons [below]) were “chartered” (actually given “cognizance,” but why split hairs?) under King Henry VIII as long ago as 1492. That was a big year for other reasons, too.

FRCS: A doctor with those initials after his or her name is a “Fellow of the Royal College of Surgeons.” The history of surgery is intertwined with barbers. Thus in the 16th and 17th centuries, your doctor would have been part of the “Company of Barber-Surgeons.” Barber-Surgeons administered leeches for bloodletting, extracted teeth, and performed other medicinal practices in addition to taking care of hair and beards. Barbers and Surgeons have dramatically different roles here in the 21st century, enabled by new understanding in the fields of anatomy, pathophysiology, radiology, and coiffeurology.

Turning stateside, we have our own traditions that have parroted our longer-historied brethren across the pond.

FACP: Such a doctor is a “Fellow of the American College of Physicians.” The ACP is the largest single specialty organization (Internists) in the U.S; its membership is second only to the AMA (which is comprised of doctors from ALL specialties). The ACP is an infant, having only been incorporated in 1915. Can you say big anniversary party in a few years? It’ll probably be as well covered as that wedding….NOT!

FACS: By now, you’ve figured out the pattern. A doctor with FACS after his or her name is a “Fellow of the American College of Surgeons.” The ACS is headquartered in fancy digs in downtown Chicago. It started in 1913, a couple of years before the ACP. According to their website, a surgeon can only become a fellow after they “…have passed a rigorous evaluation, and have been found to be consistent with the high standards established and demanded by the College.”

In other words, when your doctor’s card has any of these initials after the MD, they have a special seal of approval. Maybe not as flashy as Kate’s dress, but pretty impressive nonetheless.

You Want Fries With That?

Improving customer service in health care.

Hospitals are aiming for that top box.

Next month the Cleveland Clinic will host its second annual Patient Experience /Empathy and Innovation Summit.

If you’re a long time reader, you’ll remember some posts from last year’s first-ever summit. [Here, here and here.]

The Cleveland Clinic, always a newsmaker, is a world leader in this area because they have raised Patient Experience to the c-suite level: they have given one of their physician leaders the title Chief Experience Officer (“CXO”).

Imagine a huge three day gathering of doctors, nurses, designers, artists, and executives all intent on making things better for patients.

Wait, did he say designers and artists?

Yes. Medical facilities are taking the patient’s perspective into account more than ever in their architectural designs and renovations. And visual arts and music promote a healing environment-something hospitals have not usually been known for (can anyone say “sterile”?).

Why all the fuss? I mean, it’s nice that health care is entering the 21st century in terms of informatics (O.K., just call it computers) and other technologies. It’s not a big leap for competitive health care enterprises to compete on amenities, right?

This movement goes way beyond amenities, though. Here’s why:

Through a program called HCAHPS (pronounced “H-Caps”), the government is incentivizing hospitals to do their best on patient satisfaction surveys. And there’s money on the line. Under Medicare’s value-based purchasing plan (link warning: very boring reading), hospitals will start getting docked reimbursement money if they “underperform” in the domains of quality, safety, and patient satisfaction. No more business as usual.

Just like the issues of safety and quality, patient experience has come to the fore as an issue that hospitals and health care enterprises can no longer ignore. They don’t want to lose money. I call it a win-win. Do the right thing and get rewarded for it.

The thing is, most hospitals think they’re near the top in terms of patient satisfaction. This is an example of the Lake Wobegone effect. In the real world, not everyone is above average.

To really simplify the patient satisfaction scoring systems (there are many out there, but Press Ganey is the 800 lb. gorilla of the hospital performance measurment industry), ask yourself two questions about your doctor or hospital:

  1. Would you come back again?
  2. Would you recommend the service/facility/professional to a family member or friend?

If the answer is yes, would you be “highly likely to recommend” (i.e. 5/5 on a survey scale) in your enthusiasm? That’s the “top box” answer that hospitals are striving for.

Think of the power you’ll be wielding as this takes effect in the next 18-24 months.

If hospitals, doctors and nurses start thinking about your comfort first, health care will really be changed for the better. Let’s just hope that no one gets so bogged down with our new computer charting (informatics!) that we become even more emotionally (er, I mean professionally) distant.

Programming Note

Best Selling Stuff

If you’ll be anywhere near Iowa City April 21-23, check out “The Examined Life: Writing and the Art of Medicine” Conference. I’ll be on a panel Saturday morning with doctor-bloggers Michelle Au (“The Underwear Drawer” and author of the extremely soon-to-be released This Won’t Hurt a Bit (and Other White Lies) and Rob Lamberts (“Musings of a Distractible Mind“).

We’ll be talking doctor blogging: the whys the hows and the whatevers!

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