Thursday, February 02, 2006
First impressions may be lasting, but may not be fair

By Dr. Anthony Policastro
Nanticoke Memorial Hospital,
Medical director

The Ford Motor Company recently announced that it was laying off thousands of workers. That surprised a lot of people. However, there was a good reason. Ford's share of the market has dropped. Toyota, Honda and Nissan's share of the market increased. The interesting thing is that statistically speaking the large quality edge that Japanese cars had over American cars disappeared after the 1980s. Many people do not realize it and still hold the belief that there is a large difference. The result is that they continue to buy cars at a higher price with little difference in quality to justify the costs. We see similar things in medicine. I experienced that in the military. When the draft ended in the 1970s, the military no longer could draft new doctors. It had to provide scholarships instead. The scholarship students had to finish medical school and residency. That took about seven years. In the meantime, the military had to rely on recruitment. Many of the recruits were individuals who could not maintain a civilian practice because of the way they interacted with patients. When they became military physicians, they made patients unhappy for those reasons. The drafted physicians left the military in the 1977 time frame. The scholarship physicians began arriving in 1982. For that five-year period many people based their impression of military medicine on the physicians who provided care during that time. By 1982, things changed as new physicians straight out of residency became the majority of military physicians. However, it was until about 1990 that I still heard patients complain about how bad military medicine was. Things are no different in the civilian world. I went to a restaurant in Salisbury when it first opened about six years ago. Service was terrible and so I have never gone back. It may have had a bad night. However, it will never have me again as a customer. In the medical field, people often assume that if there is a bad result, someone has done something wrong. That is not necessarily the case. In addition, if patients deal with an individual who does not communicate well, they may generalize that to mean that the individual is not competent. Once that kind of assumption is made, it may take years to realize that it was based upon limited information. The assumption may be passed on to friends and neighbors even when it it's not true. It is very difficult for patients to judge medical care. They can judge the cleanliness of the office. They can judge the friendliness of the people. They can judge whether their complaints are being heard. They can judge whether they understand what they are told about their illness. They can judge how clear the instructions they receive are. Regardless of how good the care itself was, patients will develop impressions about that care based upon the things that they can judge. If those impressions are negative, they may last for a long time. They may be based upon a single portion of the encounter rather than the entire visit. The result is telling stories to others that become exaggerations. The one-hour wait may become a five-hour wait. The shortness of breath may become turning blue. There are many other examples. A decision about the quality of medical care is difficult. It is very subjective in nature. It is similar to deciding about the quality of a car. You can think something is poor quality even when the statistics do not support that. If enough people think that, you will have an impact. The impact on military medicine of people who thought it was bad was very frustrating to those of us who knew we were giving care that was as good and in many cases better than the civilian physicians. We had physicians straight out of residency who brought with them the latest methods. We knew that was good. But, we could not always convince the naysayers of that. Ford knows it is making better cars than it used to. It knows that the quality is comparable to those made in Japan. However, that does not convince enough people to buy their vehicles. The result is a layoff of workers that the company cannot control.

Prescription program rep to visit center
A representative from the Delaware Prescription Assistance Program will visit the CHEER Community Center on Sand Hill Road, Georgetown, several times, to offer education and outreach support to those needing assistance in understanding the new prescription drug program. Visits are set for:
  • Tuesday, Feb. 14 and 28, from 11:30 a.m. to 1:30 p.m.
  • Tuesday, March 14 and 28, from 11:30 a.m. to 1:30 p.m.
  • Tuesday, April 11 and 25, from 11:30 a.m. to 1:30 p.m.
For more information call 854-9500.