A nail in the Patient-Physician Relationship coffin

Brenda works as a nurse at the other big healthcare system in town. She is a bit of a stoic. During our 25+ year relationship there were times I thought she didn’t like me until I realized what a no-nonsense personality she possesses. Thus it was upsetting to see distress in her face and hear her frustrated tone as she said, “You’ve been my doctor a long time, but I have been told that I can only see doctors in our system for my visits to be covered on my insurance.”

This came as no surprise to me. Just a few weeks earlier our hospital president made the same announcement to our employees. It is infuriating to hear relationships destroyed with a flippant “We have good doctors here. There is no reason for our employees to see doctors in other systems.”

First of all, a 25-year relationship with someone makes for a damn good reason to continue to see them. And yes, we have great BloodPressure2doctors in our system. But sometimes better talent is in another hospital. I want my patient to benefit from the best talent available. And sometimes a better physician with a bedside manner that engenders patient trust trumps a “best” physician. Trust goes a long way in helping patients heal.[1,2,3] Creating more silos for our patients is not the answer to improving care but in these days of tightening budgets regardless of how much “patient engagement” rhetoric is thrown about, the bottom line is what is most on the hearts and minds of the system CEOs.

As administration continues its attempt to be transparent, I may scream on hearing one more “faith-based platitude”. I do not believe that putting dollars before patient care is a religious value. On the competition’s side their mission statement urges quality health care in a manner that responds to the needs of the community and also honors a faith heritage. Regardless of the faith heritage,  shattered trust is not a community need.

In the aforementioned meeting, our hospital president also stated that discussions to join with the competition for  supply volume discounts were in process. How about negotiating the salvation of patient-doctor relationships with them as well? Systems can continue to insist on patients using the facilities where they work for testing and procedures but this strategy could encourage doctors, regardless of where they work, to continue to have privileges in BOTH systems. Then we have a win-win for patient employees, their doctors and the systems.

As hospital networks struggle to balance their budgets in this competitive marketplace, here is my prediction: healthcare systems will survive based on the level of care they give the patients they serve, not by destroying the trust that patients put into those systems and their physicians. As Karma will have it, what goes around, comes around. Or if you prefer, in your faith-based work culture: Proverbs 26:27 – Who so diggeth a pit shall fall therein: and he that rolleth a stone, it will return upon him.

1. Effective physician-patient communication and health outcomes: a review. Stewart, MA. CMAJ : Canadian Medical Association Journal. 1995 May 1; 152(9)1423 http://www.ncbi.nlm.nih.gov/pmc/articles/PMC1337906/
2. Better Physician-Patient Relationships Are Associated with Higher Reported Adherence to Antiretroviral Therapy in Patients with HIV Infection. John Schneider, MD, MPH. et al. J Gen Intern Med. 2004 November; 19(11): 1096–1103. doi:  10.1111/j.1525-1497.2004.30418.x http://www.ncbi.nlm.nih.gov/pmc/articles/PMC1494791/
3. Assessing the effects of physician-patient interactions on the outcomes of chronic disease. Kaplan, SH, et al. Med Care. 1989 Mar;27(3 Suppl):S110-27. http://www.ncbi.nlm.nih.gov/pubmed/2646486


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One thought on “A nail in the Patient-Physician Relationship coffin

  1. Re : Wear the white ….
    I live in Australia and I dread the thought that our health system will go down the service path that exists in the USA. I have been reading the Inspire site for several months now and am appalled at the lack of service and control by health providers as to whether a patient can have a drug or not. Surely the need of the patient is the best determined by the treating physician or surgeon.
    Whilst our public system has some gaps in it, it is there if you really need it. Even as retired professionals, both because of significant health issues, we have struggled to maintain our top health coverage. Only recently have we turned to the public system when I was diagnosed as having infiltrating breast cancer. In this instance the public system gives me better access to medical resource such as a top surgeon ( even if he is an an old school God), oncologist, breast care nurses, social welfare and psychological services and radiation. All paid for by the taxes I paid for during my 42 years in the workforce. Our healthcare providers are now employing healthcare professionals and offering proactive health care services. There would be a mass exodus from the private sector if the private health insurances tried to determine who could have what / when.
    I would have been like your stoic nurse. Why change a system if it isn’t broken, just to safe money so they can pay their CEOs and administrators more.

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