The "effort" was measured in RVUs, which are an imperfect measure of how much effort a doctor puts in and is based on what is documented--so a 2.6% increase in RVUs likely represents additional effort that was not documented and would be very hard to measure. Regarding the margin of error, the confidence interval around this effect (on page 29) if I'm eyeballing it looks to be about 1%-4%. And to your point, I think it's pretty plausible that a small amount of additional effort to "go the extra mile" for your boss might lead to meaningful differences in outcomes.
So I don't know... maybe wear a top had and monocle next time you have to head to the ED? Joking aside, I would imagine that much of this effect is a subconscious bias, and one way to avoid such biases is simply to get your doctor to slow down a bit by asking things like "are there any alternative explanations for what's going on that are worth testing for?" or "are there other reasonable treatment options besides what we've already talked about?" Most of us wouldn't (and shouldn't) be offended by such a question, and it forces us to pause and reconsider, even if for a moment.
As a patient, you don't have to be in the military with their clear ranks to feel that you are secondary to the MD's interests and priorities and to be treated as such.
I had a recent exam experience with an MD Ashley in the Stanford Sports Cardiology department that was extremely negative.
I was made to wait a full 1 hour and 45 minutes before the MD appeared in the exam room! He claimed that he had an "emergency".
Then, after waiting 9 months to see this specialist on the recommendation of others, with no examination and based solely on what his PA told him and that I subsequently repeated for him, he proceeded to tell me that the problem I was describing was a figment of my imagination and I really did not have the problem I was there to see him about (intermittent shortness of breath, primarily under exercise).
The MD was quite stubborn about holding onto this diagnosis. Myself, I was almost speechless and did not know what to say that would be civil. Subsequently, I realized that this was clearly a GASLIGHT diagnosis, something that I had heard about from others but had never experienced myself.
Stay away from this department/MD if you don't value being treated rudely, disrespectfully and arrogantly.
Wow, thanks so much for all of these really great thoughts. The cultural aspects of both the military and military medicine I imagine are hard to understand for those, like me, who have not been a part of it. Particularly your point #4 there with the dynamics of the senior enlisted who technically don't outrank officers but carry a lot of power nonetheless is intriguing, and reminiscent of dynamics within civilian health care hierarchies.
Regarding the "2.6%" more effort finding - that seems to me to be within a typical margin of error.
However,the later finding of 14% less hospitalizations suggests something real is happening.
So how do I fool my doctor into thinking that I am someone important?
The "effort" was measured in RVUs, which are an imperfect measure of how much effort a doctor puts in and is based on what is documented--so a 2.6% increase in RVUs likely represents additional effort that was not documented and would be very hard to measure. Regarding the margin of error, the confidence interval around this effect (on page 29) if I'm eyeballing it looks to be about 1%-4%. And to your point, I think it's pretty plausible that a small amount of additional effort to "go the extra mile" for your boss might lead to meaningful differences in outcomes.
So I don't know... maybe wear a top had and monocle next time you have to head to the ED? Joking aside, I would imagine that much of this effect is a subconscious bias, and one way to avoid such biases is simply to get your doctor to slow down a bit by asking things like "are there any alternative explanations for what's going on that are worth testing for?" or "are there other reasonable treatment options besides what we've already talked about?" Most of us wouldn't (and shouldn't) be offended by such a question, and it forces us to pause and reconsider, even if for a moment.
As a patient, you don't have to be in the military with their clear ranks to feel that you are secondary to the MD's interests and priorities and to be treated as such.
I had a recent exam experience with an MD Ashley in the Stanford Sports Cardiology department that was extremely negative.
I was made to wait a full 1 hour and 45 minutes before the MD appeared in the exam room! He claimed that he had an "emergency".
Then, after waiting 9 months to see this specialist on the recommendation of others, with no examination and based solely on what his PA told him and that I subsequently repeated for him, he proceeded to tell me that the problem I was describing was a figment of my imagination and I really did not have the problem I was there to see him about (intermittent shortness of breath, primarily under exercise).
The MD was quite stubborn about holding onto this diagnosis. Myself, I was almost speechless and did not know what to say that would be civil. Subsequently, I realized that this was clearly a GASLIGHT diagnosis, something that I had heard about from others but had never experienced myself.
Stay away from this department/MD if you don't value being treated rudely, disrespectfully and arrogantly.
Wow, thanks so much for all of these really great thoughts. The cultural aspects of both the military and military medicine I imagine are hard to understand for those, like me, who have not been a part of it. Particularly your point #4 there with the dynamics of the senior enlisted who technically don't outrank officers but carry a lot of power nonetheless is intriguing, and reminiscent of dynamics within civilian health care hierarchies.