Tuesday, April 27, 2010

Three Key Factors In The Physician- Patient Relationship

Perhaps this is better titled "Patient-Physician" relationship. The old days of Marcus Welby as doctor knows best are gone. Today's physicians need to deal with a much more patient centered culture. There are a number of factors that affect this new dynamic but three are emerging as key to the maintaining a strong relationship between physicians and their patients.

1) Knowing your patient and being in sync with them builds more compliance. Generally patients are taking over more control of the relationship they have with their doctor, but not all of them. It is important for the physician to know how active a role the patient wants to play and coordinate his or her communication at that level. A study published in the May issue of the Journal of General Internal Medicine looked at patient prescription refill records. The study found that patients that are of the same mindset as their physician regarding the balance of control were more likely to take their prescribed meds. Patients with high personal control beliefs about their health were 50 percent less likely to adhere to their medicine regimen if their physicians didn't share their belief in patient control.

2) Practicing defensive medicine damages the physician-patient relationship. Physicians often feel compelled to order tests that have a low probability of being helpful simply out of fear of missing something and being sued later. Patients with high personal control beliefs about their health enter into this as well. OBs may do a C-section that is not totally indicated simply because the patient demands it. A survey of physicians by Jackson Healthcare reported that two thirds of them feel this is harming the physician-patient relationship. Seventy-two percent think this negatively affects patient care. And one fourth of Cardiologists admit to ordering unnecessary tests strictly out of fear of being sued. Clearly this environment is destroying the trust that used to exist between physicians and patients.

3) The emergence of the medical home model will totally change physician-patient relationships. This model is being highly touted under healthcare reform as a cost effective way to expand coverage to the many who were previously uninsured. Under this model the role of the primary care physician will be expanded to cover care that was previously done by specialists and much of what was done by the primary care physician will now be done by physician extenders. This will severely restrict the role of specialists unless they sign on to play more of a primary care role in the medical home. The primary care physician will now have more responsibility for more patients while spending less time with them. His role will be supplemented by physician extenders who will form their own relationship with patients.

All of the factors are forever changing the dynamic of that most basic unit of healthcare, the physician-patient relationship. Have we really made progress or were we better off with Marcus Welby making house calls with his little black bag?

More on this later.

Mark Brodeur

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