Patient-doctor bond linked to better quality care
Patients who are directly connected to their primary care physicians are more likely to get preventive screenings according to a Boston study that examines the relationship from the physician's as well as the patient's point of view. Its conclusions may add to the debate on how doctors are paid.
Having regular access to health care has long been linked to quality, but researchers from Massachusetts General Hospital and Harvard Medical School explored the importance of patients having their own personal physicians.
Looking at the medical records of more than 155,000 patients at nine physician practices and four community health centers in the hospital's primary care network, they found that patients who not only named their own doctors but whose doctors also identified them as "my patient" were more likely to get screenings for cancer, diabetes, and coronary artery disease compared to patients not linked to a personal physician. These patients saw different doctors in a practice or health center.
Although the patient-physician connection was more common among people who are white, speak English, and have health insurance, the bond with a personal physician was a bigger factor than race or ethnicity in whether a patient got guideline-recommended preventive care. Being insured was also not as important as being connected, according to the study, which was completed before Massachusetts passed its healthcare law mandating near-universal coverage.
"We need to understand why certain patients are connected to personal physicians and why others aren't," Dr. Steven J. Atlas said in an interview.
Atlas and his co-authors, who report on their study in the Annals of Internal Medicine, were surprised by the variation in connectedness that they found across the 13 practices, ranging from 46 percent to 71 percent of patients. The different settings share clinical and administrative systems, including electronic health records, and have the same management structure.
"That's a huge difference," Atlas said. "That has important health policy implications if you think about paying physicians or practices based on the quality of care they provide."
Physicians have objected to pay-for-performance programs that compensate them based on how many of their patients get recommended care. Last year the Massachusetts Medical Society sued the state's Group Insurance Commission alleging its ranking of physicians based on cost and quality measures hurt physicians and patients because it was based on a flawed methodology. Physicians were sometimes punished for the cost of care for patients they did not treat, the suit alleged.
The willingness or ability of patients to establish a relationship with their doctors may play a role in connectedness, too, Atlas said, in which case holding the physician or practice accountable may not work. Patients facing socioeconomic or language barriers as they navigate the healthcare system may be less likely to connect with their physicians.
"The doctor may be doing a great job, but it may be a much more challenging population," Atlas said.
In an editorial, Dr. Andrew B. Bindman of the University of California, San Francisco, says the measure of patient-physician connectedness would be more valuable if it included not just screening for certain diseases but also improved health and lower costs.
"Clearly, we need to learn more about the role that patient preferences and provider behavior play in forming (or undermining) productive health care relationships," he writes.
Atlas said what they have learned about connectedness can affect how healthcare is delivered.
"If patients can't come in during 9 to 5, we have to figure out a new way. The face-to-face office visit is just one model of care," he said. "We are using this information to understand where we are doing well and where we can do better."
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It's all about control. And, the federal government is power hungry right now..The feds want control of the patient, the physician and payer. The quality issues they quote are a rue. Common sense has show if the Doctor works for the patient the patient benefits , the Physicians is more motivated and the patient has a better healthcare expierence. LOOK AROUND THE WORLD!!! Very few Physicans want to work the the Government or an insurance Co.
All this electronic medical records propoganda is crazy.. The future will be dominated by automatic health installations . These will be disease guidelines , designed by the Federal Govermnment that automatically download and populate your physician"s electronic record. These "updates" will be mandatory downloads into your physician's EMR. . Then your physician will be forced to treat everyone the same. No innovation unless oked by big brother. SO EMBRACE HEALTHCARE CHANGE AT YOUR OWN RISK>
The NY Times has been paying closer attention to some of Boston's medical institutions than the Globe. A March 3, 2009, story by Duff Wilson, "Harvard Medical School in Ethics Quandary," calls attention to financial conflicts of interest at Harvard Medical School involving pharmaceutical businesses, available at www.nytimes.com/2009/03/03/business/03medschool.html.
The Times article cites but does not reference a rating system for medical school conflicts of interests developed by the American Medical Student Association of Reston, VA, available at www.amsascorecard.org. The published 2008 ratings for Boston area medical schools include U. Mass grade A, Boston U. grade B, Tufts U. incomplete and Harvard grade F. The ratings publication includes detailed methodologies using eleven criteria.
Why is this breaking news? I'm surprised the medical establishment is just figuring this out now. Or is it the insurance companies that are lagging?
Even I know that one of the most vital aspects of patient-physician connectedness is simple human communication. It's not just about physician performance -- it's also about patient benefit, which may depend on how well the physician is able to communicate the necessity and benefit of certain types of screening. Given the (perceived or real) potential for iatrogenic harm -- unintended harm or other negative consequences from medical procedures -- what patient would elect to undergo complicated, potentially distressing testing/procedures, if they weren't explained in detail by an invested healthcare provider who clearly has the patient's best interests at heart?
The medical establishment cements its power and control by shrouding its concepts, terminology and procedures in language that is inaccessible to the average person without a background in Latin, a burning desire to learn more about their own physiological systems, and a stubborn resistance to discouragement from doctors who resist sharing the information they have with us... or just don't have the time explain what we need to know in order to be healthy -- not to mention stay alive. But that mode of retaining power and control is backfiring on practitioners who refuse (or simply don't know how) to empower their patients. Forming an actual connection between physician and patient can go a long way towards facilitating proper screenings and testing and necessary procedures... improving "physician performance" in the process.
And it would go a long way towards helping doctors live up to their Hippocratic Oath -- so that they may indeed Do No Harm.
The reason most people don't have their own primary doctor is because most of the doctors are lazy quacks, who don't want to keep their offices open during regular business hours--and who certainly don't want to be personally on call during evenings or weekends. I had a problem with an infected boil and called my mom's doctor at 11 am on a Friday during the summer. The doctor had already left for her weekend holiday! I was told to go to the ER instead, where I had to spend $3000 in out of pocket expenses instead of being able to just go to the doctor's office, pay $300 for an office visit and another $100 for my antibiotic prescription. Do you think I'd go to this quack again?
My father had a primary care doctor, and when the doctor was off for the weekend, he left another physician in charge. My father was admitted to the hospital with pneumonia. They couldn't reach his regular doctor, and the covering doctor didn't even have her beeper on!
I'm sorry, but if you want to earn $250,00 a year and consider yourself a professional instead of simply a medical mechanic, you have to put up with the aggravation of being on call for your patients. That's the doctor's FIDUICIARY DUTY. Unfortunately, most of the physicians in this Commonwealth have forgotten about it. Their patients get treated with no respect, so they won't even consider contacting their doctors for a routine screening, because for the most part, the doctors go crazy and send them for a lot of unnecessary, expensive tests. Tell me what the justification is for charging $750 for a CBC, perfomed in the hospital's own lab?
Most doctors see their patients only as dollar bills, NOT as people for whom they have undertaken a sacred trust to keep well. If you want patients to name a specific doctor for their care, you must first begin by educating the doctors to treat us as PATIENTS and NOT as merely CUSTOMERS!
Anything that fascilitates doctor-patient communication would bring them closer and ehnance the quality of health care. It doesn't necessarily have to be expensive, as there are already technologies out there that just need to be incorporated. An example is the use of email for doctor patient communications. Who else still uses the phone for most routine exchanges. Its a no brainer, especially since there are existing on line services that are easy to use, free, and HIPAA compliant.
I think Barbara, author of comment number four, offers a good example of a dissatisfied healthcare customer - disappointed in a system that at one time was personal and caring. She and many others fail to understand that her father’s close relationship with his doctor was ruined by insurance micromanagement and cost-control measures - not free market forces..
This blogger might want to review your comment before posting it.
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