The patient-physician relationship is in critical condition

The state of medicine in America is a highly discussed topic today. The reports are rarely positive. Politicians battle for control over their vision for health care and predict doom and gloom if the other side “wins.” The cost of health care continues to rise for employers and employees. Physician burnout and dissatisfaction are on the rise. We hear from politicians, media outlets, and others on how to fix the health care crisis. The two groups we hear the least from however are patients and doctors.

In the next few paragraphs, I will outline why the patient-physician relationship is in critical condition and how resuscitating this relationship could prove to be a valuable step in healing our health care system.

As physicians, the first step is to look in the mirror and address our faults. It has been well documented that physicians have less control over patient care now than at any other time in American history. Most of us are employed and work for larger organizations. Private or small group practices make up a minority of practice opportunities and so autonomy in patient care has been lost. Mega-mergers are occurring across the country, consolidating power and control of regional health care. The loss of private practice opportunities is an economic reality. The cost of running a small practice is not feasible for many now due to ever-changing regulations, electronic medical record requirements and lower reimbursement for services. There are certainly benefits to larger health care organizations, such as more collaboration opportunities and convenience-of-care coordination for patients. However, physicians must continue to do what is right medically and lead rather than follow when it comes to delivering health care.

Despite shifting practice demographics, the larger problem we face collectively is a lack of unity. All too often, we are competing rather than collaborating. The turf battles between specialists and protecting our territory hurt physicians. Yet, we fall in line with regulations imposed on all of us which we know are illogical. We have become customer service specialists, held to the most stringent patient satisfaction expectations, even when doing the right thing medically opposes this. For example, if prescribing an opioid is clearly not indicated, but the patient demands this, in some cases no matter how compassionately we present this, patients will not be happy. This is considered a negative outcome. The electronic medical record has become an enemy to patient care and erodes face time with patients. More time than ever is spent documenting irrelevant information on a computer. When an otherwise healthy patient comes into the office for a finger sprain and the computer flags a blood pressure of 121/81, a counseling session on hypertension must be documented.

Implementation of government programs such as MACRA along with ever-changing coding and billing requirement takes valuable time away from direct patient care. Individually, we lack the power to change any of these, but together — if we put pride aside — significant changes can be made.

Sadly, as with many relationships in our culture now, the patient-physician relationship has become more adversarial. Patients are bombarded with surveys after each office visit now to rate their experience. There are numerous venues, including social media, to voice their opinion. Many times, there are positive comments, but even one negative comment out of ten can draw the attention of administration. Our medical system is also highly litigated. I believe physicians should be held accountable for their demeanor with patients as well as mistakes or negligence. However, a system that increases patient-versus-doctor conflict is not good for either party. The cost of medicine increases for all when we focus on avoiding lawsuits or satisfying patients above the practice of ethical medicine.

Patients also have less control over their health care. Employer-based insurance plans provide little to no choice in coverage options. And if employment changes, then so does the choice of care. Physician turnover and shortages in some areas is significant which limits access and continuity of care. Government health care plans have limited coverage, and due to low reimbursement, many facilities do not accept these plans. Yet, costs to patients keep increasing while reimbursement to physicians is decreasing.

So where is the money going?

Physicians and patients have become commodities in a system controlled by others. We have been pitted against each other in many cases, while health care brokers position themselves to gain profit and control of the system.

In the end, patients and physicians are key stakeholders in the health care system. Although we face challenges as patients and physicians, I am convinced we still have an outstanding health care system. I believe we can make this even better with collaboration.

Physicians, let us work together, not for selfish gain but for the betterment of patient care. Let us work to eliminate the distractions imposed by others that have harmed the patient-physician relationship. Let us use technology, compassion, and knowledge to the benefit of those we care for.

Patients, help make your voice known, not only about your patient experience, but your desire to have more choice in your health care and a system focused on you and your doctor. Medical decisions should be made with you in the exam room and not the boardroom, the operating theater and not the political theater. The government, insurance companies, and health care administrators will continue to play a large role in health care moving forward, and we can work with them to improve the system. It is up to us though to make a healthy patient-physician relationship the priority.

Ryan Enke is a physical medicine and rehabilitation physician.

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