Tag Archives: trust

From the Patient’s Point of View-Why will they be Miserable?

 The 15-minute visits also take a toll on the relationship of the patient-doctor relationship. The patient who sits patiently in the exam rooms waiting patiently for the doctors to arrive for their visit and to finally speak with their physician. They have already seen the administrative secretary and the nurse, but they came here to see their physician. So, now the physician presents his or herself. Based on my complaint he or she looks in my mouth, throat and up my nose, said that my throat was inflamed and told me to see the nurse for a prescription and that I was suffering from a sinus infection with inflammation of my throat from posterior pharyngeal drip.

When I protested the drug that he wanted to prescribe he cut me short and told me to see the nurse……and he was out of the exam room. It must have been a visit that lasted for a total of 9-11 minutes, if that.

This story is becoming increasingly common. The patients as well as the physicians are feeling the time crunch as never before. The doctors and nurses feel like “running” office hours on rollerblades. Doctors have to see more patients and perform more procedures to make up for the discounted, flat or declining reimbursements.

This problem will worsen with the Affordable Care Act (ACA). Remember, millions of consumers who are gaining healthcare through the ACA begin to seek care, many of whom have never, or very rarely, have seen a doctor and therefore this patient population presents with a list of untreated problems. Often in the primary care as well as in other specialties, the patient is seen for only one diagnosis per visit. This is very inconvenient for the diagnostically/multiple disease patient. They then don’t get the comprehensive care with continuity associated with the individual patient. This is happening today as evidence by one of my patients with complex endocrine disease (diabetes and thyroid disease) who has been frustrated by these short visits with the results that her complex disease is out of control. I quickly referred her to an endocrine specialist.

In today’s world it seems that the doctors have one eye on the clock and the other on their laptop computers, typing away to capture the correct amount of “points” for the highest reimbursement for the visit.

As Roni Caryn Rabin stated in her article in WebMD, short visits take a toll on the whole relationship of the doctor –patient, which I have already stated in an important part of the good care equation. As I presented last week, we have to have a change in behavior in both the doctor as well as the patient. The office visit and the physician-patient relationship represents missed opportunities for getting patients more actively involved in their own health care. Research and the surveys show that there is less of a dialogue between the patients and their doctors, which increases the odds that patients will leave the office frustrated. Also, the shorter visits also increase the likelihood that patients will leave the office with a prescription, instead of discussion about behavioral changes like trying to lose a few pounds by going to the gym/exercise.

The physicians also don’t like to be rushed either, but for the primary care physicians and now even with specialists, time is is, quite literally money. Primary care doctors are paid mostly per visits with only minor adjustments for those that go longer than the time allocated for the diagnostic codes. Specialists who do procedures also need to see an increasing number of patients to generate a proportion of patients an increased number of procedures to compensate for the decreasing/discounted reimbursements for those procedures. The struggle is getting worse and worse with doctors thinking about meeting the bottom line, paying the overhead, having to pay staff and keep the doors open.

The pressure becomes even worse between both physician and patient when the patient has waited 9 months for his or her appointment and when the doctor comes in the exam room the patient pulls out a long list of complaints. Remember, the patient is thinking that they have waited sometimes a few months for the appointment and I’m going to try to get the most of my time that I have taken off from my work or have had to get paid childcare so that they could get to the appointment.

The situation became worse when doctors started participating in managed care networks where the doctors gave the insurers discounts on their rates in exchange for the promises to steer more patients to their office. Therefore, to avoid a cut in income the doctors had to see more patients.

In medical school the students are drilled in the art of taking a careful medical history, but studies have found that the doctors are falling short and that they have a bad habit of interrupting. A 1999 study of 29 family care practices found that doctors let patients speak for only 23 seconds before redirecting them and that only four patients got to finish their statements. Today the technical doctor of the present is often, and the interview is interrupted by the physician’s beeper, their cell phone or an email notification as their typing in the patient information on their laptops.

Communication between the physicians and their patients is important and making the patient feel they have been heard may be one of the most important elements of the healthcare equation. People are feeling dissatisfied when they don’t get a chance to say what they have to say, when they don’t get their questions answered, that they got their monies worth.

What happens when the patient doctor relationship suffers? Well, the patients lose trust in their caregivers and don’t fully engage in their care. How then do you change the patient’s behavior leading to better care, a healthy patient that leads to a more sustainable health care system?

It is predicted by this writer and physician, that with the increased numbers of patients forced into a system with less and less physicians that this relationship between the physician and their patient will get worse and worse. So, the middle class will get poorer healthcare and have to pay more for it.

Looking at the Question-Why Are Physicians So Unhappy?

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With the Affordable Care Act(ACA) you would think that physicians would be ecstatic. They will have more covered patients; that is less, patients without insurance coverage. So, why are they “miserable”?

Daniela Drake in her article in The Week magazine stated that “Being a doctor has become a miserable and humiliating undertaking.” Caring for the sick used to be prestigious and everyone admired the profession. That is except for the doctors themselves, who started seeing the changes. Today the physicians, and especially the primary care doctors, have more work to do then ever before. They work extra hours in a hectic, thankless, unsatisfying profession, which is now dominated by insurers and with the ACA, more government control, government bureaucrats, and as usual the malpractice lawyers. She further states that “many doctors feel that America has declared war on physicians,” and her research shows that nine out of ten doctors say that they would discourage others from entering their profession. In fact of my five children and their friends, I have discouraged then from considering the practice of medicine.

I know that many people have very little empathy for the doctors, since most of the non-physicians believe that all physicians enjoy the sky-high incomes of the Hollywood plastic surgeons and Medicare-mill ophthalmologists. But research shows that the life of the primary-care physician is neither “privileged” nor especially lucrative. In fact, it is not only the primary-care physicians who are “suffering” from the discounted pay scale and denial of payment, with an increase in their workload. We see the general surgeons, cardiologists, ENT, pediatricians, etc. all suffering in the new health care model.

Physicians must now cram in 24-30 or more patients a day to pay the overhead due to regulated fees and cost of filling out insurance forms, which averages $58 per patient. The addition of the Electronic Medical Record software and hardware adds, on average, $30,000 per practitioner per practice. Also, don’t forget the high malpractice premiums that physicians must pay out just to see even one patient.

If you look at the average primary care physician patient visit, the visit lasts about 11-12 minutes per patient. The ACA is now adding even more bureaucracy and pressure to cut costs. With the new pay for performance, physicians will be penalized if they don’t improve the health of their patients or see their patients more than the allotted visits without showing improvement in the care of the patient.

How then do we attract the best minds to choose medicine as a profession and to convince the good physicians to stay in practice? As Ms. Drake summarizes, “the well-being of America’s caretakers is going to have to start mattering to someone.”

We will continue this discussion as we look at both sides of the picture-the perspective of the physician as well as the patient. The shorter visits create a toll on the doctor-patient relationship, which is considered a key ingredient of good care and may actually represent a missed opportunity for getting patients more actively involved in the own health, including preventative care. This goes back to our discussion regarding changing patient as well as doctor behavior.

The question is America, are you starting to see how complex the problem is and that with poor planning the system is already broken. We must all consider the future options and how we will all force our politicians to modify the health care system to benefit all.