"People need primary care but not necessarily a physician relationship," the CEO of a healthcare system, with 30 years of experience in healthcare, when asked, "What's one conviction in healthcare that needs to be challenged?"
As a physician and patient, I find this stunningly insulting and downright dangerous to hear, especially from someone with a significant influence on the future direction of U.S. healthcare.
No doubt this is a brilliant business idea -- that is, to remove physicians from their role in guiding patients through wise medical decision-making, thus allowing hospitals to sell services directly to us, as anxious and incompletely informed "consumers."
Around the same time I came across this interview with the CEO, I also found this posed by a Goldman Sachs analyst: "Is curing patients a sustainable business model?" This was said in the context of an analysis of the implications of definitive curative medications driving down the prevalence of Hepatitis C, thus impeding the ability of more people to become infected (e.g. potential consumers).
I was delighted to find that both the CEO and the analyst had said the quiet part out loud, confirming what has been, or should have been, obvious to all of us: Dollar-driven decision-making rather than patient-welfare-centered decision-making is ascendant. Plus, now I no longer had to feel like a paranoid conspiracy theorist!
However, what frightened me even more deeply than the comments from the CEO and the analyst was the realization that they were apparently so secure in the status quo that they were not reluctant to call attention to these otherwise appalling conclusions.
The patient-physician relationship is rapidly being converted into a more expensive and less effective consumer-provider model. Dollar-driven decision-making has severely restricted the time required for patients and their physicians to establish more fully informed and trusting "partnerships," as care becomes increasingly tied up in the bottom line.
So, what will happen when the patient-physician relationship falls to the wayside?
Forming those more meaningful relationships has been repeatedly proven to assist us, as patients, in becoming more knowledgeable about, more engaged in the planning of, and subsequently more to, our mutually agreed upon treatment plans. Multiple medical studies highlight that this, in turn, in .
Business concepts like "productivity," "consumer-driven wants," and "the customer is always right" have no place in healthcare and act as barriers to getting the right treatment to the right patient at the right time. Some patients are clearly getting too much healthcare, while others face insurmountable difficulties accessing the healthcare system equitably, resulting in just 5% of all patients accounting for of the country's healthcare spending in 2017. Of this population, the top 1% (as ranked by their healthcare expenditures) accounted for 22% of total healthcare spending, and the bottom 50% represented just 2.9% of total healthcare spending.
We need to find a middle ground between the healthcare paternalism of the past and the deceptively appealing consumer model propping up the false notion that our healthcare can be safely approached as a DIY project, with unrestricted access to whatever "providers" of services are able to talk us into wanting. In fact, we need to have both the benefits of high-tech medicine and the intrinsic healing connection of both high-touch and high-talk medicine.
It is only through a trusting and mutually respectful one-on-one patient-physician relationship that we can safely navigate the vagaries of modern healthcare. We therefore need to incentivize primary care for both patients and physicians alike. This will help address the of U.S. healthcare costs that are "," the of prescriptions that go unfilled (while half of the filled ones are improperly taken), and the U.S. healthcare literacy rate of . Patients should not be too quick to reject medical advice simply because they don't understand it. Physicians and patients alike must put in the time and effort to learn and understand together the condition or illness at hand.
There was a time when the relationship between the patient and physician was all that we had, because there were limited or no science-based, effective, diagnostic, or therapeutic interventions available. The nonscientific interventions that we jointly resorted to were at times harmful, and at other times clearly therapeutic. We now acknowledge that humans are a complex biopsychosocial species. With that understanding, we must stop trying to shoehorn biopsychosocial problems into a narrow, strictly biomedical model, and instead incorporate psychological, environmental, and social factors into our practice.
It is reasonable that as we learned more about the causes of and treatments for diseases, patients would become less exclusively reliant on their relationship with their doctor. However, it is not at all understandable why we would consciously choose to enfeeble this relationship within the therapeutic armamentarium. We are all suffering from the unintended side effects of that poor choice. I believe that we can and should promote a dialogue on how we, both medical and nonmedical individuals alike, might reassess the direction in which medicine is heading.
, is a 40-year career board certified emergency physician (now retired), and author of the recently published book, , from which this piece was adapted.