The doctor-patient relationship must remain the central focus of good health care. Diminish or hinder that relationship, and no technological advance, funding system, or government intervention in the world will be able to compensate. Many complaints about present health care systems can be seen as evidence of relationship dysfunction, not in the least due to the interference of third parties, administrators, payers and insurers, who wield the financial clout. Transparency is non-existent. Business considerations outweigh those of ethical medical practice. And patients bear the brunt of these influences.
There is a fundamental economic principle that has been ignored. Lower the margins, and turnover has to increase. Cut the fees paid to doctors, and encourage “higher volume, lower care” practice. This benefits no one, being nothing other than a “lose-lose” situation for all parties that will drive up costs further down the line.
There is a very good way to recognize transparent medical practice, one that goes right to the heart of the doctor-patient relationship, one built on trust. My belief is that truly high class medical practice of this nature should be acknowledged, and remunerated accordingly. But how?
The way a doctor communicates with his or her patient is critical, and no more so when it comes to discussing the pro’s and con’s of medical or surgical treatment. Fully informed consent is a critical element of good medical practice. There is no moral, ethical or legal argument that can be made against it except when the patient is incapable of understanding for whatever reason. Patient outcomes are improved, complication rates diminish, hospital stays are shortened – almost every aspect of patient care is enhanced, including decrease in ultimate cost. The risks of litigation are diminished. This is real “win-win” for all parties.
The challenges of providing fully informed consent, however, are considerable. It takes time to say what must be said, and even more time to document the process. 70 percent of what patients are told is forgotten immediately after the consultation. Who decides what information is relevant or not? Can the process be delegated to a person other than the surgeon? These considerations are amongst the reasons fully informed consent is generally very poorly managed. And it becomes really important when something goes wrong. Consent is the first area that a litigation lawyer will look at when assessing the merits of a potential malpractice case.
There are doctors who go out of their way to provide fully informed consent, but the time and documentation restraints have remained obstacles. Some bold visionaries have tried to address this problem in various ways, beyond the scope of this post. There is very carefully crafted and beautifully presented technology available that delegates this responsibility completely to a computer, which, in my opinion, is a bit scary.
The end result of fully informed consent is documentation that details the level of care taken by a doctor to ensure that the patient’s outcome is improved. Almost no other area of decision making in medicine carries the same level of transparent and visible care. In this, the consent process can become an ethical yardstick by which high quality care is recognized.
Everybody deserves high quality care. Adoption of a high standard of consent taking in all areas of medicine is easy to do with the technology that is currently available. And the doctors that deserve to be the champions of medical practice can easily be recognized by insurers, payers, Medicare and patients, and paid what they are worth. This, in the context of changing and challenging health care systems, is an emphatic “win-win.”
Martin Young is founder and CEO of ConsentCare.
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