U.S. health care is going to hell in a handbasket, but only as patients can we alter this. Centers for Medicare & Medicaid Services (CMS), hospital administrators and we patients are all guilty of worshiping at the altar of “patient satisfaction.”
It’s not that patient satisfaction is necessarily a bad thing. As a patient myself, I certainly seek out convenience and satisfaction. A UC Davis study in 2012, however, showed that patients who reported being most satisfied with their care had greater chances of being admitted to the hospital, higher total health care costs, higher prescription drug expenditures and — wait for it — higher death rates, than patients who were less satisfied with their care.
Granted, this is just one study. And no, logically, I don’t believe that satisfaction leads to a greater risk of dying. The link is more likely the reverse. We report being satisfied when we get more medications, health care services, and hospitalizations, and that those things lead to an increased risk of death.
Just one example that more health care is not necessarily better for us is the universal agreement that the overprescribing of antibiotics has led to the pervasive, costly, and potentially deadly problem of antibiotic resistance.
This is particularly concerning for that portion of physical symptoms and self-limited complaints, for which antibiotics, hospitalization, and extensive health care services are not needed. This is a determination which your physician, and not CMS nor your hospital’s CEO, is in the best position of guiding you through.
Think that I’m overstating that concern?
Here is the answer that the CEO of a $1.5 billion health care system, with 30 years of experience, gave in response to questions in a published interview.
Question: What’s one conviction in health care that needs to be challenged?
Answer: “That every patient needs a primary care physician. As we start stratifying our patients into distinct populations based on their health needs and develop that insight further into consumer-driven wants, we are finding that a substantial sector of the population does not want or need a primary care physician relationship. People need primary care but not necessarily a physician relationship.”
This is stunningly insulting, disturbing, and downright dangerous to hear as a physician, especially coming from someone who is helping to drive the direction of U.S. health care.
Patients cannot change this alone, of course. But we need to take the initiative in a concerted effort in forming a true partnership with our primary care physicians. The obvious goal of this proposed patient-physician partnership would be to sustain the health of the patient, with each participant having different expertise. The patient’s expertise would be in how we feel and what health goals we hope to achieve, while the physician’s expertise would be in the advisability of those goals and how to achieve them most safely.
As physicians, we are beyond desperate for our patients to adopt a more informed and engaged role in their own health. Multiple studies confirm that greater patient engagement in their own health care leads to better health outcomes.
For the “bean counters,” it takes no great insight to conclude that the more patient care encounters that occur, the more dollars that can be charged. Thus, the constant pressure on physicians to “be more productive” inevitably equates to spending less time with individual patients.
We are all guilty, patients and physicians alike, in allowing this transition to occur. That is: allowing nonmedical people to position us as widgets on an assembly line and call the shots regarding how we physicians and patients spend our time together.
There is a surprisingly consistent finding in the medical science literature that patients who adhere to treatment plans have half the mortality rate than less adherent patients. How much of this is due to the “placebo effect” or the “healthy adherer effect” remains unclear.
Significantly, the patient’s choice to form this type of informed and engaged partnership adds no additional financial cost to anyone. A no additional cost health care intervention that halves your mortality rate is invaluable! Why then aren’t we hearing more about this?
The reasons are twofold. Firstly, because the medical investigators themselves can’t fully explain it, nobody can “own” it as a research finding or a prescribed intervention. This is from the conclusion of one study showing a 50 percent reduction in mortality:
It is surprising that better adherence to placebo should be associated with reduced mortality since placebo by definition has no specific biologic or disease-modifying activity. Therefore, placebo adherence must be a marker for some other factors responsible for this extraordinary survival advantage, but what those factors might be remains a mystery.
Having a physician partner who knows us well, who we can trust, and whose judgment we value exponentially increases the odds of accurately making the distinction between self-limited illness versus a significant disease process. This will also assist us in navigating the health care system such that we receive only that testing and treatment that is appropriate for our individual situation.
Just imagine how much better we would have fared in the U.S. had our individual responses to the COVID-19 pandemic been guided by trusted and qualified medical experts.
To make this novel partnership more feasible, I would propose at minimum an immediate 50 percent increase in the rate of pay for both adult and pediatric primary care physicians, thus encouraging more new physicians to choose those professions while allowing for more time for physicians and patients to spend together.
Drew Remignanti is an emergency physician.
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