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Trisha Torrey

Why Can't Medicine Be More Like NPR's Car Talk?

By August 23, 2010

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I've been away... and while I was on the road, I was able to indulge in one of my secret delights - listening to Car Talk. You know - Tom and Ray, Click and Clack - Saturday morning's entertainment-you-might-learn-something-about-your-car-too show.

For someone who knows almost nothing about cars, nor does she feel the need to - I just love to listen to Car Talk! From the real car-related information (who knew that smoke coming out of my A/C was really just vapor from the humidity?) to the crazy sense of humor these two brothers have... to their authentic desire to help their callers, to their Baaahstin accents (I swear this is where they staahted paahking theyah caahs.)

And then, Saturday morning, it struck me. Medicine should be more like Car Talk.

If you have never heard it, Car Talk is hosted by two brothers, Tom and Ray Magliozzi, who have been talking about cars on NPR radio stations for many many years. People call them up with their car problems, Tom and Ray make an assessment of the problem, explain in terms the caller (and the rest of us) can understand, make a joke out of it, tease each other - and move on to the next caaahler.

Here's why I think our medical care should be handled more like Car Talk:

1. They listen: Tom and Ray listen carefully to each caller. They ask questions, they assess the situation, they come to some conclusions, and carefully explain those conclusions to the caller. Are they in a hurry? Yes, of course - it's radio! and they have only an hour. But every caller feels as if he or she has been heard.

2. They discuss the diagnosis: as I listened Saturday, Tom started down one road diagnosing the problem with one caller's car - but Ray (or do I have them turned around?) said no, he thought it might be something else - and here were his reasons. They discussed it some more, and within seconds - a minute maybe - he had convinced Tom that his diagnosis and solution were closer. The caller had the benefit of both their thought processes - two heads were better than one. In addition the caller had a differential diagnosis - an alternative to review, too. Why don't our doctors do that? (There's no reimbursement, that's why.)

3. Once Tom and Ray have had that discussion, they explain it to the caller in terms the caller can understand. Enough said.

4. They work remotely - by phone. No waiting rooms, no set appointment (OK, their hours are limited - one hour per week! - but still, nobody is sitting in their waiting room reading a magazine dated 2007.)

5. They solve problems without regard to how much money they can make by their solution. Think about it - don't you think the diagnostic process would be correct more frequently if the doctor doing the diagnosing wasn't also the doctor who was going to treat? Why do surgeons recommend surgery? It's a thought - and a real possibility.

OK - there's a start... some reasons medicine should be more like NPR's Car Talk. My real point is that in the midst of trying (failing) to balance the money aspects with the care aspects of medical care, we have all lost something. Much of what is lost is what we hear on Car Talk - the attention to a respectful conversation between the professional and the body-owner, the patient.

In what other ways do you think medicine should be more like Car Talk?

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Comments
August 23, 2010 at 6:05 pm
(1) Amy Romano says:

Great post! I also like that they invite callers to let them know if their diagnosis was correct, and post this feedback on their website and sometimes include it on their show in a “Stump the Chump” segment: http://cartalk.com/content/stump-the-chumps/ For that matter, their web site is a good companion to the “office visits” they offer during their show – lots of good info on car maintenance, links to more information, the ability to download and review the audio of the visit (akin to OpenNotes), etc.

August 23, 2010 at 10:03 pm
(2) Regina Holliday says:

Great Post Trisha! You know I was listening to Car alk as I painted you. But you left out how often they ask the deeper questions. Like the time a husband called to complain that he thought his wife was riding the break on the minivan full of the kids. They went on to ask what kind of car was he driving. It turns out he had the LEXUS convertible! They recommended he talk to his about her frustrations rather than focusing on the breaks. I love Car Talk and what a great analogy.

August 24, 2010 at 1:27 pm
(3) Susannah Fox says:

Trisha, thanks so much for writing this and confessing to the world that you listen to Car Talk w/o really knowing what they’re talking about (as do I) b/c you always learn something new (ditto). I agree there is a parallel with health care – who among us doesn’t have some curiosity about what’s going on under our hoods? I will add one note: I have a friend who takes her car to their garage in Cambridge and the shop does excellent work. It’s not all talk.

August 24, 2010 at 4:59 pm
(4) Dennis (Investigator/Negotiator) at Medical BillDog says:

I’ve been accused, occasionally, of picking on the doctors, so I thought I’d try to look at this from a doctor’s perspective. Doctors keep telling me that much of what we patients and patient advocates ask is undeliverable under the current system of payment. Some of those doctors (like Bryan Vartabedian of the 33 Charts blog and Dr. Rob Lamberts of the Musings of a Distractible Mind blog) think email and telephone medicine will only become commonplace is the current fee-for-service system is changed to allow them to charge for email/telephone treatment.

I think they’re right. The pay system is broke. Look at Car Talk, for example. The Tappet Brothers don’t charge for each individual interaction. They don’t get paid on a FFS basis. They receive a salary for their radio shows.

Look around the country. Which doctors are doing telephony and email service? Which doctors are giving each patient the time they need? Mayo Clinic. Kaiser Permanente. The Seattle Group. What do they all have in common? Their physicians are on salary. No fee-for-service.

Now, I know there are others–non-salaried others, but mostly it does seem to be the doctors on salary. Know of any who are not on salary but who are open to use of email? How do they explain their willingness to spend unrecompensed time communicating with their patients? I’d really like to know.

August 24, 2010 at 5:19 pm
(5) Anne Perschel says:

What a fun way to take a new look at an old problem. The other thing Tom and Ray do so incredibly well is laugh at themselves. They are contagious – and not in the bad way. After all they – whoever that may be – say laughter is the best medicine. So shouldn’t our docs make us laugh and then laugh right along with us?

August 24, 2010 at 6:45 pm
(6) Alexandra Albin says:

What a great post and dittos to everyone’s comments here. Love Click and Clack followed by “Wait Wait, d’ont tell me.”

I am not convinced that a salary oriented model would make the complete difference. Prestige runs in the hearts of doctors. But, I could see how that would have a leveling effect.

I wish that two doctors could “regularly” genuinely discuss a patient’s diagnosis w.o their ego’s interfering. Despite the times I have gotten two doctors, including top doctors, of the same discipline to discuss my case, invariably, their comments tend to be tainted by some competitiveness. I have seen this in some of the most patient oriented doctors. It really is too bad. I am essentially having an office visit and hence paying them to discuss what doctor B or C said. Often I weed out the doctors based on their level of reactiveness. Those who are willing to play together I respect and lean towards. It is hard to weigh patient savvy against technical skill. (community of Drs I deal with are mostly orthos…that is my primary prism)

August 25, 2010 at 12:41 pm
(7) Joyce says:

Great post! While hearing about a friend’s complications following gall-bladder surgery, I realized that medicine is unique in that there is no “customer service department.” For example, Tom & Ray sometimes refer a caller to the manufacturer’s 800#. But with medicine, who do you call when you think your doctor has done you wrong? Who is his/her supervisor to whom you can elevate the issue? Is it the chief of staff at the hospital where he/she practices?

August 26, 2010 at 11:13 am
(8) Eve Harris says:

Concur with your thoughtful readers, above. Perhaps it’s really our medical insurers — and not the Tappet brothers — who are represented by the law firm of “Dewey, Cheatham and Howe!”

August 28, 2010 at 10:37 am
(9) Donna Cross says:

Terrific article! Humorous but at the same time deeply insightful. I have a friend now going through (semi-competent) medical diagnoses, and I wonder if she wouldn’t do better calling Click and Clack!

Doctors and patients alike could learn a lot from this piece. Thank you for it.

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