The physician-patient relationship lies at the heart of all medicine. It is the epicenter of care; the place where all information and data is gathered for a diagnosis and communication occurs to create effective care and compliance. It is also the point at which obstacles to delivery of care can occur and physician frustrations can mount. Every physician knows that it’s all about the patient, but some days it can seem that regulators, insurance companies and the pharmaceutical industry are conspiring to drive a wedge between doctors and a productive relationship with their patients. Is this what medicine is meant to be?
The American Medical Association Code of Medical Ethics states that a physician-patient relationship is a clinical encounter, a moral activity and a relationship “based on trust, which gives rise to physicians’ ethical responsibility to place patients’ welfare above the physician’s own self-interest or obligations to others, to use sound medical judgment on patients’ behalf, and to advocate for their patients’ welfare.”
On the face of it, that is an accurate summation of the core mission of all physicians. However, a closer look reveals the principle that physicians will place patients’ welfare above “obligations to others”. Therein lies the gauntlet – the sometimes impossible minefield that physicians must traverse to get from patient needs to the delivery of patient care. “Obligations to others” now includes federal, state and payor regulations, coding, billing and prior authorization burdens, quality and Centers for Medicare & Medicaid Services (CMS) performance metrics. It’s estimated that CMS alone releases 11,000 pages of new regulations each year – an increasingly high wall for physicians to scale. Fortunately, the AMA and the American Hospital Association are taking action and lobbying Congress, payors, and regulators for decreased regulations. The AHA Regulatory Overload Report called attention to the urgent need to back off administrative burdens, saying they cost an estimated $1,200 every time a patient is admitted to the hospital.
Patient Relationships Despite Administrative Burdens
It is possible to create productive physician-patient relationships but the effort can feel like swimming against the tide. One study shows that physicians are now spending twice as much time on documentation and other administrative work as they are with patients – 49% versus 27%. That’s not exactly why physicians pursue a career in medicine.
Despite these onerous administrative burdens, physicians focus on building relationships with patients because they know that a foundation of trust is essential for the delivery of care. Without trust, patients may not be forthcoming with information critical to proper diagnosis and treatment. They may not listen receptively and receive information that is important for care plan compliance. Trust creates a relationship in which patients will rely on the physician’s competence, skill, and goodwill.
It may be reassuring to learn that the first steps in creating a trusting relationship with patients are quite simple. Certainly, clinical complications and adverse outcomes may complicate the relationship later on, but those difficulties are easier to navigate when they occur against a backdrop of trust. The first steps to building a positive physician-patient relationship involve simple human courtesy and earnest communication:
- Treat the patient with respect
- Show empathy
- Practice good listening and make eye contact
- Ask the patient about themselves
- Explore the details of patient perspective about themselves
- Share the diagnosis clearly
- Engage the patient in setting the care plan
- Always pursue two-way conversation with the patient
- Provide closure whenever possible
The result can be mutual respect, knowledge, and shared perspectives that improve the delivery of care.
Dealing with Utilization Management Obstacles
When prior authorization and step therapy delay patient care it frustrates physician efforts, creates patient dissatisfaction and can adversely impact outcomes. The AMA believes that is unacceptable. It convened a group of patient, physician, hospital and pharmacy organizations to develop “principles on utilization management programs” that will reduce their negative impact on patients, physicians and the system at large. The management reform principles are worth reading. Joining the cause and forcing utilization management companies to reform is the best strategy to ensure timely access to treatment for patients and reduced costs for the healthcare system at large.
How to Minimize Disruptions
Physicians see patients in the middle of a busy, chaotic day. Patient interaction occurs within the confines of payor-directed 15-minute sessions. It’s an understatement to say there is no longer a relaxed approach to physician-patient interaction. However, there are ways to shut out the hectic pace of the office and concentrate on the patient at hand. The American Academy of Family Physicians tip sheet includes concrete suggestions:
- Put your beeper on silent mode during your visit.
- Close a door if outside noise is a distraction. (However, ask your patient’s permission first.)
- Limit the number of times you ask questions or interrupt when your patients are presenting their chief complaints.
- Lean forward, maintain eye contact, nod appropriately, and don’t cross your arms.
- Engage in active listening. Concentrate on what the patient is communicating verbally and nonverbally. Take into account both facts and emotions
It’s an uphill battle, no doubt about it. However, practicing medicine and healing patients is worth the fight to reduce regulations and the obstacles they create between physician and patient.
