Walter had struggled with pain on his side after a bad bout of shingles. He and his doctor had tried different treatments, with some success; on this night, however, Walter couldn’t get to sleep, and the pain was worse than ever. Walter didn’t want to awaken his doctor at 2 a.m., so he wrote him an e-mail, knowing that he would receive a response after his doctor got into the office the next morning.
Just knowing that he could contact his doctor comforted Walter enough that hecould get back to sleep. Defining the Patient-Physician Relationship for the 21st Century
The patient-physician relationship
The patient-physician relationship is key to providing and receiving excellent care, and good communications skills and capabilities are a key to good patient-physician relationships.
Busy physicians need to be available for their patients (see the Walter story above), have a broad and up-to-date clinical knowledge, and be able to see both the “big picture” and the details of a patient’s life and health.
Availability and communications for patients take time and resources, and the question (which we will hope to address in this article) is how to best manage time and make the most of modern online technologies in order to reduce physician stress, reduce the amount of time spent on “work overhead” and increase the quality of time and communications between patient and physician.
Major advances in medical technologies and practically nothing for physician-patient communications
The past 50 years has seen major advances in medical technologies – diagnostic testing, therapeutics and pharmaceuticals and medical devices. The Internet and Dr. Google have made medical information accessible to anyone and it is not unfrequent for a doctor to ask a patient if he has looked into his particular condition before the visit and receive a correct diagnosis as an answer.
Sadly, the progress in innovative medical and pharmaceutical technologies does little to reduce physician stress, improve the quality of the patient-physician relationship and improve the effectiveness of patient-physician communications.
The pressure of revenue, family and and patient demographics
A growing population places increasing demands on physician time, and the pressure by healthcare providers to “do more with less” means generating more revenue with shorter and more frequent billable patient visits.
Clinical and family responsibilities make physician time management, during office hours and at home a critical issue. In their article Time and the Patient–Physician Relationship - Dugdale, Epstein and Pantilat, published in 1999 in the Journal of General Internal Medicine report on the importance of Patient–physician communication to Patient–physician relationships.
Patient–physician communication patterns affected the health status of such patients. Office visits with more effective information gathering by patients, more information provided by physicians, more conversation by patients relative to the physician, and more expression of affect were all associated with better health and functional status.
It is not the actual time spent with the physician that affects outcome, but rather what happens during that time.
Physicians’ level of satisfaction is connected to their perception of the amount of time that they have to do their work.
Physician satisfaction contributes to patient satisfaction. In a qualitative study, Grol et al. found a correlation between higher physician satisfaction and higher quality of care as assessed by communication patterns (e.g., explaining care to patients), attention to psychosocial aspects of care, and prescription rates.
Because patient satisfaction is increased by increased patient participation and patient education activities, it is plausible that a visit rate above 3 to 4 per hour would be associated with decreased patient satisfaction.
Regardless of visit length, physicians must develop strategies to enhance the quality of care with the amount of time available.
In the context of the individual patient encounter, the most productive technique for time management is to improve the physician’s communication skills.
Ample data show that patient-doctor communication factors affect patient satisfaction and outcomes such as medication compliance.
Dugdale, Epstein and Pantilat also suggest specific strategies for patient-centered communications:
- Set an agenda early in the visit.
- Listening actively to the patient’s story in his or her own terms
- Paying attention to the emotional agenda presented by the patient
- Use empathic statements
- Solicit patient attribution. This helps manage uncertainty without wasting time. Ask the patient “what do you think is going on,”
- Take advantage of the patient’s personal knowledge
- Establish agreement on goals of individual visits and medical care by involving patients in their care
Physician time is not only a resource like any other part of the health care system, it is without question the most important resource in the patient-physician relationship.
We can make the best of that resource and make the patient-physician relationship more productive by doing 4 things:
Improve communications skills
Time management of the patient-physician relationship can be improved by improving the physician’s communication skills with patient-centered communications as described by Dugdale et al.
Improve the technology for patient-physician relationship management
Gmail, Windows 95 style user interfaces and healthcare portals are not tools for patient-physician relationship management nor do they contribute anything to reducing physician stress. Email is a terrible tool with the distractions, exposure to spam and lack of context of an ongoing patient-physician relationship. There is a better way indeed.
We can use private social networks for healthcare to connect patients directly with their physicians and healthcare providers. Just imagine the ease of posting a status update in Facebook and you can imagine how doctors can provide guidance and how patients can provide feedback using a simple, insanely effective interface. For example, diabetic patients who would normally have to visit their physician four times a month, can provide their sugar levels directly to the doctor, making his decision-making faster and easier and more precise and saving three out of the four visits.
Current EMR systems that push big data into healthcare portals and invite patients to view their medical records online do not enable a more effective, two-way patient-physician relationship communications medium like a Facebook or Google+ message thread.
Improve the patient-physician relationship with better data
The biggest unutilized resource in healthcare is the patients themselves.
The physician is the expert on the clinical issues and the patient is the expert on his personal experience.
Connecting evidence-based medicine at the point of care with patient personal experience is the best way of improving the quality of data that flows back and forth inside the patient-physician relationship.
Unfortunately, we spend billions on healthcare IT and online portals when private social networking for healthcare can connect the physician with the patient in a simple, effective and cheap manner that is universally accessible to rich and poor, young and old using a tool as simple as a browser.
Include the caregiver and family in patient-physician communications
The quality of patient-physician communications increases when we include family members who may be the primary caregivers.
The caregiver is on the scene daily – while the physician may see the patient face-to-face once every 3-6 months for 20-30′.
Leveraging caregivers as part of the patient-physician relationship is the best way of increasing trust, improving data and reducing the amount of time spent on decision-making at the next face-to-face office visit
Carol lives in a retirement home. Her thyroid condition and Parkinsons symptoms make it hard for her to get around. Her daughter Susan visits Carol several times weekly, coordinates and takes her mother to doctors’ appointments. At Carol’s first meeting with her new neurologist, she said “Please communicate with me by contacting my daughter. She is deeply involved in all of my health care decisions, and I like it that way. She researches things on the Internet and explains things in a way I can understand!”
- Just between us - Private messaging 1 on 1, group message from doctor to patients.
- Sharing that is so simple - Share your files, your guidance, your experience, your comments.