Column: The Critical Role of the Patient/Physician Relationship

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The importance of an intimate relationship between patient and physician can never be overstated, because in most cases an accurate diagnosis, as well as an effective treatment, relies directly on the quality of this relationship.

Over the years, payers and regulators have tried any number of provider reimbursement arrangements, incentive programs, quality bonuses, etc. with the goal of steering physicians to make the most cost-effective healthcare decisions for their patients.

Yet most of the systems and strategies put into place with the intent of managing or manipulating the healthcare decision-making process have not succeeded – why not?

Healthcare decision making is complex – there are rarely black and white / right and wrong answers. Fostering a quality relationship between a patient and a physician is fundamental to a successful healthcare system because that’s where the decisions are made. In discussions between a patient and his physician, data is gathered (medical history, symptoms, concerns), diagnoses are made, treatment plans are developed, support and information is provided, personal situations and values are considered, etc.

This article looks more deeply at the components of a successful patient/physician relationship (PPR) and how to address some of the challenges that exist in fostering those components.

Components of a Successful PPR

A number of forces, both technological and social, have evolved the PPR in recent years, presenting both challenges and opportunities. Up until the last 20-30 years, a paternalistic PPR was fairly typical, where the physician’s role was seen as “doing to” or “telling” and the patient’s role was that of “following”. However, in more recent years, with the introduction of the internet the widespread availability of clinical articles and other on-line advice, a more informed and autonomous patient has emerged, seeking, desiring and often demanding a more collaborative PPR.

Within this new collaborative culture, the key elements of a successful PPR are:

  1. A payment structure with limited impact on provider decision making
  2. Access to comprehensive information on the patient
  3. Physician knowledge/expertise to diagnose and treat/refer
  4. Trust and open communication
  5. Focused time

While advancing technology, access to information, and patient engagement has created a number of opportunities for improved care, a number of challenges have also arisen.

Physician-side Challenges

With rising healthcare costs, multiple players trying to get providers to manage care at lower cost, and “enlightened” patients among other things, physicians are facing increasingly complex challenges as they try to treat their patients. While a doctor may know what an ideal PPR looks like, any number of issues can make that difficult to foster.

  • Lack of patient face-ti me due to other responsibilities
  • Lack of actionable information on their patients
  • Mixed and/or misaligned financial incentives
  • Informed, empowered, and demanding patients

Continue reading the column here.