The once coveted doctor-patient relationship needs resuscitation if health care reform has a chance of surviving. Hippocrates defined this relationship over two thousand years ago and the insurance companies have managed to destroy it in less than twenty. Doctors and patients, once partners in this equation, have become adversarial and untrusting -- and they are both entitled to be angry.
The patient has every right to be angry with their doctor. Doctors are perceived as not caring, taking forever to return phone calls and review test results, never available on nights or weekends or worse, when patients are hospitalized and needing our attention the most. Doctors are seen as the reason patients are constantly being denied the latest therapies and diagnostics they know are available but not able to access. Patients are very sophisticated now with the avalanche of health information from the internet and general media, and they don't want to "settle" for second rate options. Patients now come to their appointments well-informed, with excellent questions, and a desire to be included in the decision-making process about their health. They see their doctor as the roadblock to that access. Threaten the trust in any relationship and the wheels will start to coming off.
The doctors are likewise angry with their patients. Our advocacy for patients has sadly morphed into an adversarial relationship. The constant losing battle with insurance company regulators to provide the best care options makes patient advocacy impossible. We are limited in the time we can spend with our patients, who blame us for rushing them through their appointments, because we are mandated to see twice the number of patients for half the reimbursement. The time once spent to educate and bond with our patients has been replaced by arguments over why they can't get the best medication or the MRI they need. Add in the physician's vulnerability to senseless malpractice suits and the burdensome paper work required to maintain this fractured system and no wonder we're all really cranky. This creates bad feelings and prevents the nurturing of a true partnership between us and our patients. This relationship desperately needs therapy, and without it, any new health care paradigm will fail.
The third party in the therapist's office must be the insurance company. They should be sitting in the front of the room, or, more appropriately, in the corner facing the wall. Do you know what percentage of insurance executives go to nurse practitioners for their primary care visits or belong to HMO's? How many of them are denied the latest scans, sophisticated blood tests, vaccines, and non-generic drugs? Ever wonder why doctors don't make house calls anymore? It may shock you to know that if we do we will be denied malpractice insurance!
So how can we repair the relationship between the doctors and our patients? Patients can help by preparing for their visits with all their questions written down and, if necessary, planting themselves between the doctor and the door until they are satisfactorily addressed. Find out how your doctor wants you to communicate with them -- phone, email, fax, or perhaps notes attached to cupcakes. Most importantly, listen to your doctor's advice about eating well, exercising thirty minutes every day, and making sure you're getting enough rest (more than 60% of people have a sleep disorder which contributes to many diseases, but this issue rarely is discussed in that abbreviated visit). Doctors, for their part, need to respect the needs of our patients to answer all their questions and offer education and proactive advice -- discuss their options regardless of limitations imposed by insurance carriers. We must partner with our patients to offer short and long term goals that continuously improve the patient's odds for a healthy and longer life. Most important for physicians is to pay attention to the "non-medical" issues that shape our patient's health -- their combined stress from home and work. Offer healthy alternatives that will prevent substance abuse and other destructive choices. This may take an extra few minutes but will ultimately be a jack-pot for restoring the relationship Hippocrates had in mind. We as physicians must never stop advocating for our patients.
As for the insurance companies, what I think they should do is move their operations into the used car business -- there certainly is an opening now and they are well-trained to step right in.
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