Patient-Centered Communications – A Great Differentiation Strategy For Primary Care Physicians

More and more it seems that primary care physicians are becoming commoditized.   You know…where there is nothing to differentiate one group of physicians from another group of physicians down the street.

I really don’t understand why primary care physicians don’t make more of an effort to “stand out” from the competition in some meaningful way.   Being a former hospital marketer, I am even more surprised that hospitals systems, which now employ many primary care physicians, have been so slow to recognize the benefits of differentiating their physician partners from those across town.

That’s why I was surprised with a TV ad which I saw in my local San Jose market run by John Muir Medical Center in Walnut Creek California.   The ad is the first I have seen which uses their physicians’ patient communication skills to differentiate themselves from competitors.    Given that poor communication is the number one complaint most people have about their physician,  this is a great strategy.

In truth I can’t say that John Muir’s physicians are any better at communicating with patients than any other groups of physicians.  I would need to see evidence beyond that captured in patient satisfaction surveys.   You know…the same satisfaction survey everyone uses with the same wonderful results.   What I can say is that if in fact the ad is factually correct, John Muir is on to something.

With Patient Expectations Of Their Doctor’s Communication Skills Being So Low – It Easy For Physicians With Good Communication Skills To Stand Out

Poor communications is an issue for  my doctor and I.   I am reluctant however to change doctors because I doubt that other physicians are any better when it comes to patient communication.   But what if they were!

What if the physicians affiliated with a particular hospital system actually did communicate measurably better than their competitors?  With the advent of the Patient-Centered Medical Home, there’s lots of talk about primary care physicians becoming more patient-centered.    Why don’t hospital executives begin helping their physicians, both independent and employed, become more patient-centered in the way they communicate with patients through training programs?   After all patient-centered communication is the gold standard  for how provider should communicate with patients.  Even more interesting would be those same hospitals teaching patients how to effectively engage their physicians in discussing ways they can get more involved in their own care.

Just imaging patients walking out of your physicians’ offices amazed and delighted that their physician:

  • asked their opinion
  • invited their questions
  • was present in the moment and
  • actually listened to what the patient had to say.

Effective patient centered communication is one great way for primary care physicians and their hospitals partners can to avoid being commoditized and to stand out as market leaders.   Are you ready?

That’s my opinion, what’s yours?

18 responses to “Patient-Centered Communications – A Great Differentiation Strategy For Primary Care Physicians

  1. Great list. There’s a couple of additions I’d make:

    > Just imagine patients walking out of your physicians’ office with a piece of paper documenting the consultation and the advice given.

    > Just imagine patients having anytime, anywhere mobile access to their records, your consultation report(s) and a way to digitally connect with you

  2. Yes, better communication, and, particularly, access to records would be HUGE for us as patients.

    However, I don’t feel that there is a real market incentive for primary care physicians to change the way that they practice. They already have more patients than they can handle. Until we train more pcps–open more medical schools, lower tuition, and provide incentives to enter primary care, nothing will change.

    • Watch the video – there is a huge incentive for physicians to change the way they practice – it’s called patients voting with your feet and fingers of Twitter. If you don’t like your doctor leave and find a better one…and be sure to tell your 1,000+ followers on Twitter and Facebook why you are leaving your physician. That sounds like good motivation for physician behavior change to me..

      • “If you don’t like your doctor leave and find a better one…and be sure to tell your 1,000+ followers on Twitter and Facebook why you are leaving your physician”

        Many pcps are not accepting new patients. There is often nowhere to go if you don’t like the way that you are being treated, and the next doctor is likely to practice in the same way, because he/she will face the same set of incentives and disincentives.

        I happen to like my pcp. He is responsive and a good advocate. He practices the way that he does out of a deep sense of commitment and because of his religious/philosophical values, not because of market forces. He doesn’t make much money. Most doctors would not be willing or able to follow his lead.

  3. @Abby

    Be prepared to be surprised. Better “communication, and, particularly, access to records” can actually enhance the effectiveness of existing PCPS.

    Research on this has been published by Prof John Bachman MD in the Mayo Clinic proceedings and you can get a video introduction to this research here:

    • ” Better “communication, and, particularly, access to records” can actually enhance the effectiveness of existing PCPS.”

      Of course they can; that was my point, precisely. We have no disagreement there. The disagreement is how to make these improvements in the context of the existing system.

  4. What if each patient told us what they wanted to be able to do, when they were the healthiest they could be.. and our job as physicians was to help them and show them why what we are asking them to do, will help them reach that goal. The challenge is on us to help them meet their everyday life goals.

  5. @Ellen Barnett

    Exactly what the challenge should be.

    A challenge that I see with this is that unfortunately we currently have a system that is reactionary rather than proactive and when we want to market a proactive message we’re up against the very competitive marketing landscape where everyone’s trying to get a consumers attention.

    I also think documentation is equally critical to this approach too. Not much point doing verbal communications when we all know so much is forgotten by patients.

  6. I love the way you always single out the most over-worked and under-paid group of doctors for all your criticisms.

    Abby nails it on the head: every PCP already has more patients than they can handle.

    Blaming them for all the problems in our medical system is just speeding up the total demise of primary care.

    • Southern Doc…no one’s picking on anyone. I simply report the facts…and the facts are that the quality of physician-patient communications in primary care and specialty care is not very good. Given that primary care physicians are where most people get their care, it concerns me that the so many things (test results, diagnoses, use of clinical guidelines, etc.) seem to be falling through the cracks, much of which comes back to poor physician-patient communication. Since this affects me and my family and thousands of others..of course this is concerning.

      Look at the research yourself and you will see that things haven’t changed very much over the last 30 years when this issue first attracted researchers. The same things I am writing about here were issues back then…long before managed care, P4P, increased time demands, etc. It as Sir William Osler who had to remind physicians back in the 1870s to talk to patients since they will tell you what is wrong.

      Sir, there simply is no excuse for people getting misdiagnosed, ignored or otherwise ill treated simply because someone is too busy or overworked. If I am dissuading people from going into primary care because of this blog then they don’t belong there in the first place.

      I appreciate you thoughts as always. Hang in there things will get better.

  7. I don’t disagree with any of your concerns. We have created a system that is anti-patient, anti-physician, and pro-business. Unfortunately, I see things getting much worse.

    What I don’t find helpful to the discussion is the way, here and in other posts, you continually single out primary care physicians as the source of so much of the problem. Are their communication skills really that much worse than other physicians? Are orthopedists and neurosurgeons really doing that much better a job?

    Nobody goes into primary care for the bucks: they go into it because they like working with patients. Every good primary care doc I know feels like she is fighting a dysfunctional system non-stop every day from first patient to last. That’s why so many of them are getting out, and leaving only the mediocrities behind.

    Addendum: Don’t be fooled by all the hype around the PCMH. Look at the criteria: it’s all about data collection for the insurers, leaving even less time for patient-physician communication (if you’re even allowed to see a doc!).

  8. Southern Doc,

    Thanks for hanging in there with me. Your point is well made and taken.

    Between you and me, the quality of physician-patient communication is often worse at the specialty level. My first retinal surgeon had this annoying habit of not allowing me to ask any questions until he was ready for them…by which time I had forgotten them.

    On a related note, just about all the research in physician-patient communications done over the past 30 years has been done in primary care…and very little in specialties other than Oncology.

    There’s another factor at play with specialists (depending upon the severity of the patient’s diagnosis) The sicker you are, e.g., cancer, and other life threatening conditions, the less important good communication is relative to the doctor’s reputation for good outcomes. In other words, a patient will put up with more nonsense from a specialist than they will from a primary care doctor.

    You are absolutely right about PCMH. More of them are working to rearrange the deck chair to quality for PCMH designation than they are doing anything substantive to improve the way care is delivered. On the other hand, there are many primary care physicians who are working very hard to make the kinds of changes that do make a difference. And I have a great deal of respect for those folks.

    Thanks aging for sharing your voice.


  9. Let’s help our patients help us . Ask what their goal for thier best health is.. make a note of that.. and then we can refer to that goal when suggest a treatment or life style plan. We can get into a habit of using their own ‘hook’ of their vision of thier health, rather than trying to have them buy into our hooks.

  10. I don’t think it’s inconsistent to promote patient-centered care while at the same time advocating for better paid primary care doctors with more reasonable workloads (in fact the two are related). And since patient-centered physicians connect better with their patients, being patient-centered improves rather than detracts from job satisfaction.

    However, I would agree with southern doc that communication is important for all doctors. Singling out one specialty doesn’t really make sense. For example, I would certainly want my orthopedic surgeon to understand my dedication to continue marathon running after a bad injury, so he’d approach surgery with an appropriate level of intervention, refer me to the right PT, etc.

    Primary care doctors are very often attracted to the specialty because they get to form longer relationships with their patients, so in that sense it is even a bit perverse to focus the discussion of this problem on them. If yours doesn’t, then of course you should go out and find one that does, because they are certainly out there.

    Thanks, Stephen, for your focus on this topic! Always interesting to read what you put out there.

    • Moses,

      I for one think primary care physician’s should be better paid…as do a lot of other folks. You are right, Group Health is demonstrating the value of smaller patient panel sizes and longer visits – but then they are large enough to “afford it.” Concierge practices understand the same thing.

      Communication is important to all docs – to be sure. But I would wonder if a sub-specialist focusing on a narrowly- defined problem needs the same “curiosity” as say a FP or Internist responsible for addressing a whole spectrum of issues requiring the ability to “fineness” the clues from patients…and hold the patient’s hand while doing so.

      Thanks for your comments and t feedback! If you need a good writer for your biz let me know. I do

      Steve Wilkins

  11. The Group Health mention is very appropriate here.

    They improved patient and physician satisfaction by: decreasing each doctor’s panel size by 25%, lengthening all appointments to 30 minutes, and increasing support staff by up to 75%. Effective, but very expensive.

    Contrary to what the true-believers try to tell us, they DID NOT achieve these results by “transforming” to the NCQA PCMH model of patient care, in which the panel size is increased, appointments are shorter, and communication/engagement is relegated to non-physician members of the “team.” Not the direction most of us want to take.

    • Southern Doc,

      Maybe they do PCMH different in your part of the country. Speaking from a (Northern) payer’s perspective, the Group Health actions that you described – decreasing individual PCP panel size, improving access and communication and increasing support staff:PCP ratios – are exactly what we hope to achieve through PCMH. It costs much less to have the PCP giving more attention to our members in the primary care setting than to have them showing up at the ER or getting admitted and readmitted for preventable situations.

      The reality that primary care is under-utilized AND underpaid is a key tenet of PCMH which is why PCMH models include a PMPM on top of ffs (our PCMH programs, anyway.)

      I’m a little confused by your complaint about relegating communication/engagement to non-physician members of the team. Certainly, some tasks should be shifted from the physicians to mid levels or non-clinical staff when it is appropriate. (Why else would you increase support staff?) The goal should be a staff that operates as a team and allows everyone to function “at the top of their license.”

  12. I have to agree with southern doc, medicine especially primary care medicine is being turned into a “mass produced” assembly line style delivery of care. The easiest fix to the medical system wouldn’t be to train physicians in how to manage in a horrible system, but rather to change the horrible system by giving physicians more time and reduced patient burdens.

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