By Jaclyn S. Nadler, MD
In an age of metrics and data, it is almost impossible to quantify the importance of relationships. When reading the article,”Trying to put a value on the doctor-patient relationship” in the NYTimes, I recall thinking well of course there is value to the physician-patient relationship. It seems like a no-brainer, but how can you prove it. I cannot think of any physician who would argue that having a long-term relationship with a patient they have known over time and understands their family dynamics and personal stressors wouldn’t have a more solid base to draw upon. The problem is how do you quantify it? How do you put a measure on a personal connection, on the ability to learn nuances about someone’s personality or the trust that develops over time between two human beings. Dr. David Meltzer, an economist and primary care physician attempted to do just that. The results of his study supported his theory that strengthening the relationships between patients and their physicians can decrease medical costs and improve patient health. This is music to the ears of administrators whose primary goals are to improve outcomes and decrease costs.
But what about for the patient? From personal experience I have seen patients crave personalized attention in our broken healthcare system. With the push for corporate branding over the personal relationship between a patient and their doctor; patients are feeling like they are just a number. They are shifted around to other “providers” for convenience and I believe to strategically destroy the bond a patient has with their physician and coerce their allegiance elsewhere. Patients who are part of large healthcare organizations are not longer Dr. So and So’s patients but rather the patient of ACME healthcare. Patients don’t understand this, they come to us because their neighbor or friend recommended a specific physician to now find they are just a part of a large organization. If their physician is fired or leaves the group they are many times given no explanation or information of how to follow that doctor; rather they are randomly assigned to a new “provider”.
Corporate medical institutions and insurers count on this. They love the ability to manipulate patients at their whim. They do not want patients to have an allegiance to their doctors, otherwise they lose all the control. As more and more physicians became employees it is harder and harder for them to have any direct control over their practice. With productivity demands, time constraints and so many interferences (EHR, regulations, etc…), physicians are losing the ability to develop these ever important relationships directly with their patients. Our schedules are packed so tight, we find it difficult to add on sick patients who need to see us. With the implementation of patient call centers, patients are now diverted from being able to speak directly with the office staff who know them, to being funneled to eagerly waiting walk-in clinics and urgent care centers many times staffed with less qualified providers who do not have these established relationships. This many times lead to delays in care and missed diagnoses.
Relationships are equally important for physicians. Rushing people through, day in and day out, merely trying to get a glimpse of their health concerns and find a quick diagnosis to treat or more complex problems to refer. Physicians do not have the luxury of time to let patients explain what ails them. I recall from medical school that if you listened long enough to the patient’s story, they would tell you what was wrong with them. But in our current healthcare climate of 7 minute visits, patients are cut off too soon. Physicians are not given the time to properly examine and develop a differential diagnosis or the time to implement an appropriate plan of treatment. We are not able to utilize the full extent of our knowledge since referring a patient to a specialist for something we could manage takes less time and is more efficient. Our time is cut short and documentation demands too high. We lose a critical part of what makes us a great physicians and that is the rapport we develop with our patients and the insight gained by seeing them over time. Loss of this ever important relationship with our patients is an important contributing factor to physician burnout.
Patients need these relationships with their physicians to develop trust. Trust allows them to divulge information they may withhold from someone new to them. Trust allows them to feel confident in our recommendations for care. Over time that relationship results in a mutual respect for one another and aids in shared decision making which facilitates patient compliance and empowers patients to participate in their own care. Anecdotally, patients frequently tell me how much they appreciate the time I take to explain a recommended treatment. I give them the risks, benefits and alternatives. I discuss evidence based medicine, but I also share what I have seen from experience. Because of our relationship they trust that what I’m recommending is in their best interest. They trust me to take care of their family members. For me these relationships are what keeps me going. It’s the joy I get out of being a doctor.
Will we ever have data to support the value of the physician-patient relationship? The above article definitely gives it some credibility. But for those of us practicing physicians, I say who cares. Why do I have to prove to anyone other than myself and my patients that the time I spend and the relationships I develop with them needs to be quantified. If these relationships make me a better doctor and my patients are getting better care for it, that is all that matters.