What can patients really expect from their physicians today?

It may seem odd during these turbulent, cynical times, but a lot of people still trust their personal physician. People that have high trust in their physician tend to believe that their physician;

* Is up-to-date with the latest medical treatments
* Keeps track of all important aspects of their health during and between visits
* Can be depended upon to act in the patient’s best interest

This broad-brushed view of patient trust may seem quaint and antiquated today given all the health care safety and quality issues we read about today. But this is what the research tells us.

But are these beliefs still appropriate today? What can patients realistically expect from their personal physician today in the way of health care?

If the industry press is to be believed, the biggest problems facing primary care physicians these days is lack of time and lack of adequate reimbursement. As a patient, this makes me wonder what my doctor is not doing for me because 1) he/she is not being paid to do it or 2) there’s not enough time to do it.

Some of the today’s shortcomings are well documented in the health care literature:

* On average, US adults receive only 50% of recommended care
* Up to 30% of adults are walking around with undiagnosed hypertension and diabetes
* 66% of people with hypertension do not have it under control
* Up to 20% of discharged hospital patients will be readmitted with 30 days even though they are considered preventable

But is the average patient really aware of everything that seems to be falling through the cracks these days, e.g., care gaps?

What do you think? If you were to make a list of what patients should or should not expect from their physician, what would that list look like?

Steve Wilkins is a former hospital executive and consumer health behavior researcher who blogs at Mind The Gap.

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  • http://nostrums.blogspot.com Doc D

    “*Up to 30% of adults are walking around with undiagnosed hypertension and diabetes
    * 66% of people with hypertension do not have it under control”

    It would help if these data were accompanied by information on how many had been advised of their problem but failed to follow up. I read a study recently that showed only 50% of insured patients follow their doctor’s advice to obtain colonoscopy.

    I worked in a health care system where electronic records were available. It surprised me to see how many people said they were taking their blood pressure medicine, when I could see they hadn’t obtained the prescription ($3 co-pay), or who would take it for a while after I prescribed it, then stop, even though we had discussed why continuity. was so important.

    It would help to know which patients are falling through the cracks, and which are jumping into them. That way we could target the real gap, and the reasons for it.

    As regards preventable re-admission–a separate problem–work needs to be done to improve this. But, my impression is that the expanding definition of “preventable” contributes to the rate of re-admission. Many doctors are concerned about outcomes-based quality measures that don’t account for patient variability and unpredictable influences.

  • http://www.freda.org.uk Freda

    Your comments about the patient having trust in their primary care provider resonate with me. I live in rural Scotland and I cannot praise our local GPs enough.

  • http://www.drmintz.com Dr. Matthew Mintz

    Steve,
    Keeping up-to-date, tracking health during and between visits, and acting in the patient’s best interest are all very reasonable expectations. However, they are not practical, at least for patients who use health insurance to pay for primary care or for the primary care docs that accept their insurance. Reimbursement rates are so low that primary care physicians rely on high volume, short visitis. This leaves little time for the important things you have mentioned.

    @Steffan Lozinak; Don’t confuse reimbursement with salary. Most doctors who went into primary care did not choose this field so they could afford big houses, fancy cars, expensive vacations, or :”bigger TV’s.” While care has gotten more complex, reimbursement rates from insurance companies have gotten lower. In order to keep a practice financially viable, docs need to see more patients in less time. Students are not choosing primary care because cardiologist makes more money, they are avoiding primary care because they don’t like trying to do so much in so little time as well as managing the hassle factors such as prior-authorization.
    “Until I see a doctor…..” I strongly encourage you to see Kevin’s post “The Vanishing Oath is a film patients must see.” Here, a family physician talks about getting a second job…at Blockbuster! It has really gotten that bad.

  • http://www.silvercensus.com/ Steffan Lozinak

    YOu know, I gotta be honest, I am really sick of hearing doctors complaining about not getting paid enough. I have never met a doctor who was suffering financially.

    OK, yes I understand how much work goes into becoming a doctor, but that is why you should only become one if you are truly interested in helping people.

    If you are a doctor, and you ever claim that you you are not getting paid enough to help someone, then you shouldn’t be a doctor in the first place.

    Until I see a doctor that is living below the poverty line or that has to get a second job (interns excluded) in order to provide themselves and their families with the basic necessities of life, then I will not feel sorry for them. Just because you can’t afford a bigger TV is nor reason to complain.

    • crocoduck

      The “helping people” argument is a simplistic, juvenile leap of logic which fails to hold water. The inevitable end of that line of reasoning is communism. The trash collector “helps” me with my need for sanitation. The farmer “helps” me with my need for food. Both are arguably more important to a sustainable society; both arguably “help people” more that the physician. Therefore, by your statement, trash collectors, farmers, physician, in fact, workers of just about any profession, can only complain if living below the poverty line. Truly from each according to his ability, to each according to his need.

  • rezmed09

    How about asking some more questions and looking at some of the assumptions?

    “On average, US adults receive only 50% of recommended care”
    How many have been offered that care but declined? Lots of patients refuse colonoscopy, Mammos, and more aggressive lipid treatments…. It is mostly not a cost issue – they just don’t want it.

    *” Up to 30% of adults are walking around with undiagnosed hypertension and diabetes”
    How many of these patients have been told but are in denial… I cannot begin to tally up the number of patients told they have DM and “forgot about it.”

    * 66% of people with hypertension do not have it under control
    How many patients really take all their meds every day? How many eat a healthy diet? How many patients with DM or HTN or CAD are eating bacon or sausage or ribs or fast food regularly?

    “* Up to 20% of discharged hospital patients will be readmitted with 30 days even though they are considered preventable”
    Yes this is a problem. And it is usually because: they don’t take their meds, their families are decompensated, or they eat salty foods and come back volume overloaded.

    Come on folks, the physicians aren’t the solution to all these problems. Yes bad discharge planning happens and lots of patients don’t get 4 meds to get their Glucose down, or 3 meds to get their PB down. But if the “expectation” is that the docs are going to somehow make the patients buy and take all their meds, or make sure the patients stop eating potato chips or fast food every day you are missing the big picture.

    The expectations on physicians to fix the many complex and deleterious behaviors of our patients seem to be rampant in our society. Where is personal responsibility?

  • TrenchDoc

    The answer to the question is: “Patients can only expect from doctors what the insurance company will allow them to have.” Proof is just 2 hours ago I saw a male patient with abdominal pain, fever, blood in stools and WBC of 13000. The insurance company denied the CT Abdominal scan. I had only one treatment option: start PO antibiotics and go to the ER if you get worse. As long as the insurance companies set the payment menu they also set the treatment menu as well.

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