How Has the Physician-Patient Relationship Changed?

Sandra Levy

Disclosures

November 08, 2017

Many doctors claim that the most fulfilling part of their job is their relationships with patients, but because so many people rely on the Internet for health information these days, those connections have changed. What's the nature of the physician-patient relationship now, and is there anything physicians can do to improve it?

Medscape Business of Medicine senior editor Sandra Levy spoke with Halee Fischer-Wright, MD, president and CEO of the Medical Group Management Association, at MGMA's recent annual conference in Anaheim, California. Here are edited excerpts of their conversation.

Medscape: We all know that the physician-patient relationship is important to both groups. But who is it more important to?

Dr Fischer-Wright: Both of them need the relationship. I don't think there is a "more" issue. The reasons are different. The role of the physician and the role of the patient are changing.

The role of the physician used to be that the physician was the receptacle of all medical knowledge, and you had to have a relationship with the physician to have that medical knowledge bestowed upon you in the form of the therapeutic relationship. That has changed. The information has really become a commodity. The relationship that the patient has with a physician now is for the physician to curate the information and customize it for the patient's particular circumstance.

For the physician to do a very effective job, the patient really needs to have a partnership with the doctor so they get to know you, your needs, your social determinants of health, to make sure that the therapeutic plan they are prescribing makes sense to you. From a patient's standpoint, what we know is that when there is trust and communication in the relationship, the outcomes are significantly better, the quality metrics are better, the outcome measurements are better, the patient satisfaction is better, and, most important, the costs are less. Both parties need the relationship but for very different reasons.

Medscape: Today more patients go on the Internet to get medical information. How has that changed the physician-patient relationship?

Dr Fischer-Wright: When I was early in my practice, about 20 years ago, I would say, "I will only see patients who have no access to the Internet." In 2017, everyone has access to the Internet, and not only that, they have it on their phone or watch.

The role of information has shifted. Everybody has access to information, but useful information—information that serves you, and being able to sort out what's valid and what's not valid. That is where the burden is today. It used to be that we accepted everything that was on the Internet as true. In this day and age we question everything, and that's where a good partnership is really helpful—to sort through all of that.

Medscape: What negative impact does the Internet have on the physician-patient relationship?

Dr Fischer-Wright: It's a distractor. Because of the burden of regulation and documentation for billing practices, physicians aren't making eye contact with patients. You are not going to typically be online in a patient visit, but you may be afterwards.

If a patient comes in with a lot of questions and you have a lot of research to do to answer those questions, you have only a finite amount of time. If you have 15 minutes allocated to be with that patient and they have lots of questions that need to be looked up, you are going to have to take it out of that time. I advocate that we shouldn't be taking it out of that time. We have to figure out how to get more time back.

Medscape: Will the situation improve if physicians communicate more about their dissatisfaction?

Dr Fischer-Wright: We know from [our experiences from] the early 1970s to now that talking about your dissatisfaction by itself doesn't lead to meaningful change. We need physicians and providers, people who work in the practice, as well as patients, to be willing to make change at a grassroots level. We need to stop looking for a silver bullet from either the government or health insurers to fix healthcare. We need to take that burden on ourselves.

If people say, "I will shift to doctors who spend time with me; I will shift my health insurance to places that treat me like a person and not like a number," then we will see a shift. The thing that is helping people is that more of the healthcare dollar—how much we pay for healthcare—is being shifted to people, and so they can vote with their dollars.

Medscape: Many patients switch doctors whenever their insurance plan changes, and they don't seem to care. What are your thoughts about this?

Dr Fischer-Wright: It happened a lot 5-10 years ago. Certainly with consolidation of practices and consolidation of health insurance, we don't hear about that as much as we did in 2012- 2013. That's not one of the major driving complaints.

In the Northeast, in New York, Boston, and Connecticut, we hear a lot about physicians, primarily internal medicine doctors, who are shifting to concierge care. We don't see that a lot across the country. I don't think the density of the population or the wealth exists to subsidize that on a broader scale.

Dr Halee-Fischer Wright is the author of Back to Balance. The Art, Science, and Business of Medicine.

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