Working Paper of Public Health Volume 2012 - Azienda Ospedaliera ...

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Azienda Ospedaliera Nazionale“SS. Antonio e Biagio e Cesare Arrigo”Working Paper of Public Healthnr. 14/2012past experience was negative, a mobility process will start towards a place where theperceived effectiveness is higher. Obviously, this perception might be linked to personalexperience as well as experiences of other people close to the patient. This means thatpatients are not able to recognize the validity of the medical treatment suggested by thephysician but, based on previous experience, they might believe in that prescription. This isexactly the cognitive dimension that was suggested in the previous section, i.e. the belief thata patient can have about the physician.Referring to the above mentioned patient, let us assume the general practitioner’s easier wayto face the issue, that is to say, prescription of tests and/or medical examination, as well aspotential hospitalization. After these tests, assuming the presence of several public medicalcare suppliers and the patients’ freedom of choice among them, where will they behospitalized to receive the prescribed treatment? Could the choice of a medical center beguided by the above mentioned process?A medical center is simply a set of people with specific medical knowledge and technicalinstruments to make diagnoses and give medical treatments. This means that the medicalcenter’s reputation reflects the patients’ trust in these workers; that is to say, the centre’sreputation is affected by each single medical activity of these workers on the patients. Thesepeople need the patients’ trust to perform their work. Otherwise, if these sick people do notbelieve in their saviors (i.e., the center has a bad reputation or it has failed a validationprocess), a mobility process will be performed, as described above. Moreover, consideringthat the medical centers’ activity might be more invasive than the simple examination of ageneral practitioner, this trust will necessarily be greater. This is exactly the behavioraldimension, i.e. the physician’s approach to the clinical case, which confirms or disproves aprevious good/bad belief and might lead to non-validation.According to the proposed background and taking hospitalization into account, even if thereis an information gap among the parties or there are no previous experiences, people wouldbe pushed by an internal force to move towards a better medical center. This force could bedefined as the patient’s survival instinct, i.e. a force able to distance the patient from badmedical centers, although this is only a perception and they are not truly aware of theimminent risk. Like a gazelle might unaware of walking into the lion’s den, a patient mightunaware of putting his/her head into the lion’s mouth. What could help both the gazelle andthe patient is their perception that they are on the borderline, that is to say the perception ofan imminent risk. The force behind this perception is precisely their survival instinct.3
Azienda Ospedaliera Nazionale“SS. Antonio e Biagio e Cesare Arrigo”Working Paper of Public Healthnr. 14/2012Obviously, here the risk concerns the inappropriateness of diagnosis and the prescription of amedical treatment which could kill you. However, there is still an issue to be analyzed: whatcould affect the perception of good or bad medical care supply? In other words, what couldaffect both the cognitive and the behavioral dimension?As a gazelle might be alarmed by an unusual sound made by an inexperienced predator;patients might be alarmed by other signs given by physicians that might remind them ofprevious (bad) experiences, i.e. something that might lead these patients to underestimate theperceived probability of a successful output. More elements might shape the patients’perception but, taking the information gap into account, the dominant factor might be theapproach to the clinical case by the physician, as well as by other operators (e.g. nurses ortechnicians). In other words, even if the patient is not able to check if the physician’s action iseffective or not, the physician’s approach to make a diagnosis and/or perform a medicaltreatment might be a good proxy of the effort put in that clinical case, hence a way tovalidation the medical centre’s reputation. 5 This means that, if the behavior of these workerslooks detached, that is to say, the patients perceive that their health is not the core of theiractivity, the effect could be negative. For instance, physicians might aim to maximize theirexpected profit instead of the people’s health, thus causing a discrimination against poorerpatients, at least for what concerns the manner in which they are treated.At the same time, considering a public institution, workers can be assigned to it as aconsequence of political friendship instead of their professionalism. In other words, aphysician might not be able to deal with a clinical case, i.e. making an appropriate diagnosisor prescribing an effective medical treatment. Another consequence of this politicalprofessionalism could be at the administrative level, in the inefficiency of organization,which contributes to long waiting periods for examinations (i.e. waiting lists). Obviously, thenatural consequences of this political interference could be both a lower productivity of allthe workers, since some of them are politically untouchable and a bad example to the others,and their distance from the patients’ needs. In other words, since the activity of some workerscannot be judged by the managers, as this would be politically inacceptable, their privateinterests will come before the public interest and other workers will begin to lose motivationdue to these bad examples. Of course, the impact on the patients’ mind will necessarily benegative, i.e. a perception of lower effort made by these workers as well as doubts about their5 This work suggests the idea that a medical center might have a good or bad reputation but that only the physician’sapproach can confirm a previous good or bad experience or change the patient’s opinion. After the confirmation of a bad4
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