It�s Time to Rebuild the Patient-Physician Relationship

The rift between patients and physicians is widening, largely due to a combustible combination of physicians' time being at a premium and patients’ expectations about their care being unmet. And while the recently strained relationships hardly resemble the war waged by the Hatfields and the McCoys, the frustration felt by both parties should not be taken lightly.

“I think that primary care doctors have reached a maximum level of frustration,” says Wayne Lipton, managing partner of Concierge Choice Physicians, a New York-based company offering a hybrid model of concierge medicine. “I think the most common complaint is, ‘I really want to deliver the right kind of services to my patients, but I don’t have a way to do it.’ They’re struggling to find solutions.”

A blended approach

A little over 3 years ago, Lipton’s company began offering physicians a possible solution. Lipton explains that in a full concierge medicine model, many doctor-patient relationships are destroyed because “80 percent of the patients would leave the practice.” So CCP took a different approach; a compromise. The company developed a hybrid model where physicians can continue to see traditional insured patients while building a concierge base.

“In this environment, the patient is acknowledging that they want to participate; that they want to pay for a particular set of services,” says Lipton. “But now there are choices. And there are some patients for whom it’s just fine to get in and get out in 5 minutes. They’re not interested in a relationship [with the doctor] at this stage of their life.”

The program, says Lipton, enhances communication by providing patients with a doctor’s cell phone number, and offering a staff that is instructed to create conduits, not barriers, to the doctor. “Scheduling is set up for no more than two appointments an hour.”

Gregory Yu, MD, a family physician in Glendale, Calif., transitioned to the CCP model at the start of 2008. The reason? Yu says he felt like he was always looking at the clock, worrying about the next patient waiting for him, and not being able to devote the time to the patient that he wanted to, and that he felt the patient wanted as well. Eight months later, Yu is extremely pleased with the results. “I’m finding out new things about my patients—even those whom I’ve seen for years—that I didn’t know before,” Yu explains. “Just by knowing more about them, I think it helps me take better care of them.”

The team approach

Five years ago, Peter Anderson, MD, a family physician at Hilton Family Practice in Newport News, VA, was frustrated over decreased reimbursements that jeopardized retaining members of his staff and time constraints that prompted many patients to seek services at urgent care centers. But he recognized that there was a demand for his time.

“I realized that where there’s demand, the challenge is to capture that demand,” Anderson explains. “Patients wanted to come, so I had to figure out a way that we could deliver quality, competent care, and not sacrifice that in the midst of seeing more patients.”

What resulted was the Family Team Care concept that centers around the hiring of one or two medical assistants who, with proper training and delegation, spend sufficient time with the patient before and after the physician exam, gathering information, so that patients feel like they have been listened to and that they understand the medical counsel. The success of the new approach surprised even Anderson.

“Patients want accessibility, that’s number one,” says Anderson. “They want competent care, and they want it to be convenient. Kindness is the best word. If you’re rude or short or impatient, that drives patients away.”

Rules of engagement

Jessie Gruman, PhD, is president of the Center for the Advancement of Health, and a three-time cancer survivor. As such, she’s well acquainted with doctor-patient relationships. Yet, she says, all her work experience couldn’t prepare her for her roles as a patient.

“The learning curve I had to undergo was so great, and doing it while I was anxious and afraid, was such a burden,” Gruman recalls. “It’s not that doctors aren’t responsible to their patients. It’s just that now patients have additional responsibilities. It’s a byproduct of technology and the success of medicine.”

Gruman says one strategy that should help ease the strained doctor-patient relationship fairly easily is defining the rules of engagement. She illustrates with a shopping experience at 7-Eleven, where everyone knows the rules. Customers pick up their own hot dogs, serve their own drinks, then go to the checkout and pay. A physician’s office, however, is quite different.

“[Patients] don’t know who to call if they have questions after an appointment, or who to talk to about their insurance coverage,” says Gruman. “That’s difficult for many physician practices to understand because they don’t know what they don’t know. But [patients] are not really practiced at going to the doctor. A common set of expectations about access and interaction would be really helpful. And I believe it would take some of the wind out of the sails of dissatisfaction.”

Ed Rabinowitz is a veteran healthcare reporter and writer. He welcomes comments at edwardr@frontiernet.net.