Is My Doctor Holding Something Back Because of Lack of Time or Reimbursement?

There are a number of blogs that I follow which deal with physician-patient relationships.  I not only like to see what the author has to say, but I often learn a lot from the comments as well.  You could call it a form of qualitative market research.

As is the point of market research, I look for trends that might provide insight into my work.  Recently I have noticed two themes that run though many of the comments on blogs pertaining to physician-patient relations. Here they are:

1)      Physicians lack the time to communicate more effectively with patients.

2)      Physicians lack the financial incentive to communicate more effectively with patients.

I don’t know about you, but I find comments like these to be instructive and at the same time frightening.

I say instructive simply because such comments are a public confirmation of what clinicians already know and acknowledge amongst themselves – physician-patient communication is a big problem contributing to medical errors and patient safety issues both in the hospital and in the doctor’s office.  It also suggests that physicians simply may not understand what to do to improve their communication skill set.   I say this in light of recent studies that show how by adopting a few simple communication techniques, physicians can change the dynamic of their conversations with patient without increasing the length of the visit. See previous post

Implicit in both the “timing” and “lack of incentive” comments is the sense that physicians are withholding something from me as the patient – a preventive or treatment procedure, health education or some other information about my health condition.   It creates an unsettling feeling that your physician knows more than you do (which I expect) but that your doctor is not telling you because there is not enough time or they are not paid enough. I can see receiving this kind of a response from a professional like an accountant or attorney – but not a physician.  Not from someone who holds a certain degree of power over one’s life or death.

In truth, I do not believe that any physician that I have ever had the privilege of knowing would intentionally withhold important information from a patient because of a lack of time or money.   But the problem is that so many physicians are saying it these days.  Like the boy who cried wolf, people will eventually come to the same unfortunate conclusion that I postulated above.  After all, physicians are still the one source for health information that people rely on the most.

Maybe this is just more evidence in favor of improving the way physicians  communicate.



The Next Disruptive Innovation in Health Care – BCD

It’s extreme.  It has the power to improve safety and quality of care, enhance patient outcomes, reduce cost and significantly enhance patient and provider satisfaction almost overnight.  It is supported by the evidence, costs much less than a $44,000 physician-office EMR system and is easy for most if not all to use.  It even has a high-tech sounding name complete with a nifty acronym.  What is this disruptive innovation?   I call it Bi-directional, Concordant Discourse or BCD.

Simply put, BCD is a face-to-face, conversation between physicians and patients about topics that are relevant to both parties.

The operative term here is “relevant.”  Here’s an example. Let’s say that I am a physically active, relative healthy person with an aversion to taking medications.   Assume that my “aversion” goes back to a bad experience I had with taking a new medication and a resulting belief that medications are over-prescribed and often ineffective.  Now let’s assume that at my next visit, my doctor puts me on a statin to lower my cholesterol.   My doctor spends about 1 minute explaining his rationale for why I need to take the medication while writing out a prescription.   I take the prescription and then drive home without ever filling the prescription.

Why I do not fill my prescription

I don’t fill the prescription because, in my opinion, my doctor’s advice is “irrelevant.” It is goes against everything I believe, feel and know.   I guess I also don’t entirely trust that my doctor is “on top of things” given his busy routine.  Technically I am sure it is good care.  The problem is that at this stage of my treatment, I do not feel it is the right care for me. Had my doctor asked for my opinion about taking medications he would have known that I had a previous bad experience.   Had my doctor heard and remembered that I workout and am into my health he might have anticipated that I might prefer to work on lifestyle issues before going on medication.   Maybe then he could frame or tailor his treatment recommendation in a way that I could relate to.   In this hypothetical example, my doctor never connected all the dots, mostly because he never _______ you fill in the blank (asked, heard, remembered, anticipated, framed/tailored recommendations)…and I never forced the issue by telling him.

Bi-directional, Concordant Discourse or BCD is disruptive on so many levels

First of all BCD can be relatively simple for patients and physicians to use.  It starts with an open-ended question from the physician like “what can I do for you today?”  The patient talks for about 30 seconds while the physician listens, shows an appropriate amount of empathy, and the next thing you know a conversation is born.

Second, conversations are convenient…more convenient that biomedical physician monologues.  Heck the physician doesn’t need to worry about doing all the talking if they get the patient involved.   Conversations are also a great way for both physician and patient to learn important things from one another.

Third, relevant, highly informative conversations between physician and patients has been shown in the research literature to build patient trust, increase patient engagement, increase patient adherence, enhance patient satisfaction, improve outcomes and reduce costs.

Eventually I expect that physicians, hospitals, payers and regulators will discover what patients already know.  That a simple, focused conversation between the patient and their physician can do more to increase patient safety, quality of care, satisfaction and adherence, than Electronic Medical Records, Smart Phone Apps, text messaging will ever be able to do.  It’s time we all begin to connect the dots.

*Bi-directional, Concordant Discourse – you heard it first on Mind the Gap!

Sources:

Heritage, J. et al,  Reducing Patients’ Unmet Concerns in Primary Care: the Difference One Word Can Make.  Journal of General Internal Medicine. 2007.

Barrier, P. et al,  Two Words to Improve Physician-Patient Communication: What Else?  Mayo Clinical Proceedings.  February 2003.