The importance of the physician-patient relationship...

From: Helen Dynda (
Tue Mar 20 11:09:08 2001

Excerpts from speech on July 29, 1998 on the importance of the physician-patient relationship...By Heidi Frey, J.D.

No one doubts the importance of humanity in medicine. Providing care to the sick is a noble profession. I have heard it said that the angels were asked to safeguard the humanity in medicine, and to watch over physicians and their patients. Yet there are daily threats to the humanity and compassion of that relationship. The way we discuss health care has changed dramatically in the last 5 years. We now say provider instead of physician, and consumer instead of patient. And every time we do that one of those angels dies. My concern is that those angels are becoming an endangered species, and that the humanity in medicine will soon be gone if we do not all do our part to preserve and promote it.

The first thing we must do is protect the physician-patient relationship. Physicians are the patients primary advocates in this complex health care system, and we should not do anything to undermine that.

Advertising often features pictures of physicians. The message seems to be that if you come to us, this dedicated person will take great care of you. Here is someone that you, the patient, can trust.

I was asked to talk about patient advocacy and customer satisfaction. Those two concepts are about trust, and trust usually develops in an ongoing relationship between two people who respect each other. The physician-patient relationship is under siege right now, and has never been more tenuous or vulnerable.

The problem, as I see it, is that cost containment in medicine has been given primary importance and has obscured the trust issue. Tossed it into last place as a now-defunct priority of our health care system.

Do the health plans trust the physicians to do the right thing? Do the physicians trust the health plans? Can patients trust any of them?

Let's talk about the different systems for reimbursement: fee for service and capitation.

How many people here represent companies or individuals who have at least some capitated contracts? For those of you who do, do you use that fact as a marketing plus? Do you think the public would react favorably to this information if they were aware of it and understood the implication?

Under capitation, the physician receives a set amount per member per month, and has to pay for the patient's care of that risk pool of funds. The physician who provides more care makes less money, which creates an incentive to undertreat patients. In a primary care setting, this might work because physicians will benefit financially from keeping their patients healthy. But how does capitation work for specialists, who are only called in when a person already is sick or has a medical problem? It only gives them an incentive to undertreat or provide less care than may be warranted. How could an informed patient trust that the physician is making medical decisions in the patients best interest? Won't they always wonder if there were other tests or other things the physician could have done to treat their illness?

Under fee for service in managed care, the plans don't trust the physicians. Afraid of overtreatment, the plans scrutinize requests from physicians and apply their own medical management criteria. Some denials are appropriate, some are not. The physicians find it hard to trust the plans, who are second-guessing them and telling them what they can and cannot do for their patients.

Physicians and patients have ended up in the middle of a tug of war to reduce health care costs. They are feeling overwhelmed and marginalized in importance. Trust is being eroded. And without it there can be no patient advocacy or consumer satisfaction. Or humanity in health care.

Talk to the organizations or individuals you represent about creating a team approach to health care, where everyone partners with each other to maximize the health of the patient. Conflicts of interest will not be permitted and information will be freely communicated among the team members. Each member's opinions and views will be acknowledged and respected. Only then can an environment of trust develop, and the patient's satisfaction will likely follow.

And remember those angels and the important job they are doing. For they can survive in managed care, but only if the physician-patient relationship is preserved, protected and promoted.

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