Sunday, January 8, 2012

Putting the Doctor-Patient Relationship Into Perspective

Years ago, the Disease Management Care Blog had a pediatrician colleague who was widely admired for his diagnostic acumen, attention to treatment detail and personalized attention. As further testimony to his reputation, every physician wanted him to be their childrens' doctor. The DMCB was one of those lucky docs. The luck ran out, however, when the DMCB's spouse quickly realized that she couldn't get any appointments and even if she did, the physician's clinic routinely ran two hours late.

Persons who read this New England Journal Perspective testimonial on the joy and frustrations of a primary care career should keep that physician in mind.   That reality contrasts with Dr. Finegold's fantasy world of dedicated physicians with limitless time where 1) the personal physician individually guides complex patients through a complex health care system and 2) the doctor patient relationship is fountainhead of professional satisfaction and patient well being. That's why insurers should pay anything and policymakers should do everything they can to support this vision.

The DMCB sadly disagrees.

Primary care physicians are a precious resource. They're not only expensive, they are becoming more rare over time. As a result, use of their time and effort has to be restricted to circumstances when there is no one else who can deal with the paper work, make medication adjustments, work to increase treatment compliance, maximize the insurance benefit, deal with the social issues and provide psychological support. The DMCB thinks there are non-physician professionals who are better at these activities and do can do it far more cheaply. The solution is not more primary care physicians but more primary care physician support.

The DMCB physician colleagues may argue that the doctor-patient relationship is truly Holy Ground. Unfortunately, it is becoming increasingly apparent that there at too many patients and too few physicians to allow Dr. Finegold's indulgence of being so immersed in their patients' lives. The degree of personalized involvement described in this article may be a luxury - like open access to brand drugs, the latest technologies, the priciest specialists or a few extra days in the hospital - that society can no longer afford.

1 comment:

HealthPoints said...

It is unfortunate we can no longer sustain a model of such high physician involvement. This further extends to other increasingly stretched and expensive provider resources such as nurses. An example from the insurance industry, where our team ran the care and DM programs at the largest health insurance provider in the country, shows the truth of this predicament in population health management. There we relied on our nurses to call out to our DM program participants. These are expensive resources and because of our model in which we called patients based on delayed claims data or a schedule, it took much time to make contacts – and ended up costing nearly $80-100 per contact made. This is simply not sustainable in our economy across large populations. This is another example of where other resources and tools are needed to make these expensive nursing resources more efficient in managing the health of large populations. (We now use real time remote monitoring in our current company, HealthPoints, to make our nurses more efficient and our programs more cost effective)