The center of the health care universe will always be the patient-doctor relationship. As mentioned here before it is also the hard target for quality and value initiatives. Decades of corporate driven health care have replaced the patient-doctor relationship with the doctor-patient transaction (Relationships Over Transactions). A quick, impersonal, mostly authoritarian and more recently technology-focused transaction. It’s what administrators and managers do so why did we expect anything else when we handed over the keys?
A healthy relationship, as in patient-doctor relationship, is built upon a foundation of components such as trust, respect, communication, patience and empathy. In a service-based relationship the communication aspect is the most important and communication requires time. None of these components are required for the current doctor-patient transaction. A recent blog post entitled “Is Lack of Time Really Why So Many Physicians Are Poor Communicators?” asserted that poor physician communication is a learned behavior taught in medical school. There was an implication that the authoritarian approach to patient interaction is part of the training. HCR believes this to not be the case. It is true that physicians in training spend a great deal of time learning about the science of the body in health and disease. And it is also true that the individual human aspect of health and disease is often overlooked. The question is: does a focus on science necessarily lead to poor communication? It is probably a safe bet that no where in medical school are students taught an authoritarian approach to patient interaction. It is also a safe bet that no where in medical school are students taught to spend as little time as possible with patients. Rather, HCR believes that the current state of the patient-doctor relationship (transaction) is a direct result of the system and environment in which physicians work and practice.
Physicians, and more importantly current and past physician leaders (A Call-Out to All Physicians In Leadership Positions), are guilty of weakness and complacency. They have slowly and overtime conceded to the business school model of health care where volume trumps quality. And driving volume means less time with each patient. The only way for that to happen if for weakened physicians to completely take over the interaction and transform a relationship into a transaction. The authoritarian nature of the transaction is a coping mechanism rather than a methodology taught in medical school.
HCR believes that most physicians leaving medical school sincerely wish to do the right thing and practice their profession with pride. HCR believes that mid to later career physicians would thoroughly enjoy recapturing their autonomy and practicing medicine without a useless administrator beating them up for their numbers each month. So yes HCR believes that more time will matter (What If Physicians Had More Time?). It will signal a return to a patient-doctor relationship rather than a transaction. With more time greater things are possible. Physicians will have more time to discuss options. More time to discuss risks and benefits. More time to listen. More time to make sure patients understand. How could health care not be better for all? Except the MBA’s.