The “doctor-patient” relationship is tightly woven into the culture and history of medicine. But that special bond is under enormous pressure today. And to keep it from fraying, we need periodically to examine the fabric. Last month, the Council of Accountable Physician Practices (CAPP), representing 28 of the nation’s largest and best medical groups in the U.S., did just that.
Annually, CAPP sponsors a meeting in Washington D.C. where it invites patients, elected officials, health care leaders and policy experts. The day focuses on amplifying the voice of the patient and the physician. This year’s gathering, co-sponsored by the American Cancer Society, showed videos of courageous patients fighting and overcoming cancer and offered talks by members of Congress, the Administration, and physicians on what is ailing the health of the nation and what can be done to address it.
To prepare for the event, CAPP-sponsored focus groups across the country to compare the perceptions of patients with those of physicians about what is most valuable in health care delivery. This research was a follow-up to a survey commissioned in 2016 by CAPP through Nielsen Interactive. That survey of 30,000 patients and 700 doctors measured the degree to which physicians communicated to patients the importance of avoiding and better managing chronic illness through diet, exercise, and preventive services. The results were discouraging.
The study found that fewer than one-third of those surveyed reported receiving advice from their doctors encouraging them to increase their levels of activity, eat better and undergo the preventive screenings needed. When patients failed to make appointments or fill prescriptions, most reported never being contacted by the physician–or anyone in the doctors’ office. And 40% of primary care doctors said they could not access their patients’ electronic records when they were hospitalized or visited the emergency room, making continuity of care problematic.
A question that arose from the first survey was why these shortcomings were so pervasive. Did they reflect doctor and patient preference, or were they failures in the current health care system? To answer it, CAPP this year sponsored focus groups of consumers and physicians to ascertain what each wanted from the health care system. The data gave us a snapshot of the situation today, providing a comparison to information from a similar study done in 2007.
New research yields surprising similarities in attitude
Focus group participants were asked to rank 22 health care delivery attributes, including coordinated care, evidence-based medicine, access, preventive services, value-based care and technology, and categorize each as either most important, of moderate value or of minimal value.
And guess what? At the top of their list were the doctor-patient relationship, evidence-based medical treatment, and care coordination. Access and facilities were seen as offering moderate value, with the least importance assigned to technology and preventive services.
Physicians were asked to do the same ranking. Unexpectedly, they chose the same highest priorities as the patients–the doctor-patient relationship, evidence-based medicine and care coordination. They likewise saw access as moderately important, adding preventive services to the category. Physicians, too, relegated technology to least important, but along with facilities.
Surprisingly, patients and physicians alike highly valued evidence-based medicine, a term frequently derided in the past. And neither patients nor doctors saw technology, including the electronic health record and online tools for patient engagement, as particularly important.
Of course, for both groups, the explanations for these survey responses likely go beyond personal preference. For physicians, the cost of office-based information technology influences their attitudes toward it, as does the unwillingness of most insurance companies to pay for virtual visits. And most patients have never experienced the value modern technology can deliver in terms of quality outcomes and convenience of care, because their doctors don’t utilize these computerized systems or offer these services.
What was also surprising was the dramatic change in perception between the members of the current focus groups and the ones who participated ten years ago. Compared to the first survey, terms like coordinated care, pay for value, team-based care and evidence-based medicine were all rated far more positively by the recent participants. And the words “accountable care,” a very negative term only a decade ago and associated with bureaucratic processes and defensive medicine, were now linked with responsible medical care promoting improved patient health.
The big takeaways
Patients no longer see themselves as only patients. They also see themselves as health care consumers. As a result, they have an increasingly sophisticated understanding of the health care delivery system and the approaches that lead to the highest-quality outcomes. And for this reason, they identify the doctor-patient relationship as essential. And in parallel, they value other systemwide features as important to getting the right care. They value effective communication among physicians, the availability of a comprehensive electronic health record accessible to all clinicians and medical treatment based on the best available evidence, not anecdotes.
Compared to a decade ago, consumers today are more knowledgeable about and comfortable with terms like “evidence-based medicine,” “team-based care,” and “accountable care.” And rather than seeing those concepts and services as negative, they recognize the value they deliver. That patients and physicians alike were nearly identical in ranking the 22-item list of attributes was both unexpected and reassuring. Exactly why both groups undervalued technology in health care, accepting less functionality from these tools and applications than they do in banking, travel, and retail, remains to be determined.
I left Washington freshly encouraged about the future of American health care. As I wrote a few weeks ago, the American health care system is unlikely to change until the patient in all of us demands it. The upshot of this research is that patients and doctors increasingly agree on what is most valuable in medical care today and recognize the importance of both the doctor-patient relationship and the best approach to health care delivery. And when patients and physicians share the same perspectives, anything and everything is possible.
Robert Pearl is a physician and CEO, Permanente Medical Groups. This article originally appeared in Forbes.
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