Monday, April 1, 2013

The Patient Doctor Relationship and the Third Party

The following was a talk given to the Lackawanna County (Pennsylvania) Medical Society on the occasion of receipt of the annual President's Recognition Award.



A survey of physician attitudes conducted by the Physician's Foundation  and completed in September, 2012 received over 13,000 responses from practicing physicians and revealed the following results:  Over three quarters of physicians – 77.4 percent – are somewhat pessimistic or very pessimistic about the future of the medical profession. Over 84 percent of physicians agree that the medical profession is in decline. The majority of physicians – 57.9 percent -- would not recommend medicine as a career to their children or other young people.[1]

When I was a kid in the 40's my mother took me to our family doctor who  had a nice home on Jefferson Avenue, which is still there, with his office attached and his name hanging on a sign outside. That was the common arrangement in those days.   One thing that would strike the modern person if he went to one of those doctors is that when you went in the only one there was the doctor.  There was no receptionist or  business office or file room or ancillary personnel. And definitely no practice manager.  You waited your turn in the waiting room till he called you in.  He knew you and your family pretty well.  When you left you paid the bill and most people could afford it since in those uncomplicated days overhead expenses  were next to nothing.  For those who couldn’t afford it customarily there was little or no charge. These doctors stood out in the community and were pretty well respected.  They proudly displayed their profession, customarily attaching a small metal insignia with a caduceus to their car license plate. There was a large contingent from my medical school class who were physician's children. This was sort of my model when I decided in the 50's to get into pre-med.

I did my training in the pre-Medicare days when the hospitals had a private service and a ward service. Patients who couldn't pay the private fee were treated in open 30 bed wards by us doctors in training. There were some good aspects to that system and some bad. But during my residency Medicare came  along and the ungrateful seniors made their choice. They abandoned us to the private hospitals and semi-private rooms and experienced doctors leaving us with the skid row alcoholics and drug addicts.

So flash forward to today.  Medical care in the past involved two parties, patient and doctor. Now we have a system whose economics are dominated by third parties who are outside that relationship, and these third parties include government and insurance companies and large medical organizations which are being progressively transformed into health care managers and which are increasingly working in conjunction with each other. Our political leaders  weren't happy with the system that existed in  my training days but what we've got today hasn't turned out to be so hot either. People on both sides of the political spectrum  think that our present system is sick and I heartily agree. There are a tremendous number of symptoms of this illness but I thought I'd just pick out a couple to mention.

Instead of a simple fee paid at the door we now have an incredibly detailed, complicated system for calculating how we bill and receive payment from the third parties. Everything must be documented in detail to justify the amount of the fee to the third party payer . And document it we do because in such a system  small changes in what is recorded can make a big difference in the amount of payment.  It's becoming increasingly clear that a major selling point to doctors for electronic medical records is the automation of documentation for enhancement of level of service.

Here's another one. We all now get 2 or 3 faxes every day from the patient's insurance company  or drug plan  advising us that they've noticed that our patient has such and such a diagnosis but is not on such and such a recommended protocol . Of course they're no longer insurance companies, they're health plans and they're supposed to look at their computers and oversee what we're doing.  I'm beginning to ask myself why I bother with reading all these journals and going to all these medical meetings.  I just have to label the patient with a diagnosis and follow the protocol that pops up on the computer screen. If I don’t do it right the patient's insurance company will set me straight again. 

As much as I dislike these intrusions I'm still doing medical practice well past ordinary retirement age just like those old time doctors. Something happened recently that reminded me why. I received my application from the state for my medical license renewal  and there was the usual demographic section.  And I came to a question something like whether if I could do it over if I would still choose medical practice and struggle mentally as I might I had to answer yes - which took me back a bit because there's so much of it that I dislike intensely. Then followed a multiple choice question listing possible reasons why I might be satisfied and of course the answer was the relationship with my patients.

 I think that, besides the clergy, medicine is the ultimate personal occupation. People come to us sick or worried and invest us with a level of confidence that they give to few others, even their friends and family. To us it's sometimes all in a day's work, but it shouldn't be. We have the capacity to turn their lives around, to reassure them when they're worried, to advocate for them, to counsel them in ways that they will accept from no one else, and  at the very least when worst comes to worst to console them.  Some who come to you don't care for the way you do things and they leave but for the many that remain, as the years go by a remarkable relationship forms. I learned about this in a very personal way when I recently underwent heart valve surgery. The outpouring of concern, well wishes, phone calls, mass cards and gifts from patients, some of whom had been coming to me for 25 or 30 years, touched me deeply.

Modern medical practice is increasingly able to prevent, diagnose and treat illness. But at the same time too much of our activity is spent attending to the demands of third parties. Medical practice has gotten too complicated and there is too much unnecessary overhead. Too many computers and coders and billers and record clerks and documentation and pre-authorization and primary and secondary coverage and on and on.  Medical records are becoming more and more for the purpose of documentation for third parties and less and less for communication of information to ourselves and our colleagues and in fact because of the conflicting purpose, the communication function of medical records is continuing to deteriorate badly. The real problem about all of this is not the hassle factor. The deeply troubling thing is that the need to perform activities required by the third parties and to meet ever-increasing overhead expenses is cutting into our fundamental purpose, that is to spend time with our patients.  Talk to any patient. Our taking time with them is what they value most.

More troubling to me than that however are the efforts by third party regulators and planners to continue to reorganize medical practice. In other words what has been done already isn't bad enough. In this view we are part of an overall system, managers of the patient's health, following protocols and guidelines to assure uniformity and economy,  and of course we are to be managed as well.  One begins to get the ominous feeling that the usually off-base notices from the health care plans might take a mandatory tone and that our EMR's might start presenting us with treatment protocols that cannot be declined.

But being part of a system that manages the health of a group of patients is not the way I view what we do. Medical practice is a service relationship that starts with an individual with a unique medical concern.  Each one of us has attained a certain body of knowledge and what we do is to take that knowledge base, modified by our experience, and we use  the resources available to us and our colleagues in our community and apply it to the problem of that individual person sitting in front of us who comes to us seeking  help and advice. We're not there to fix society, or to worry about the financial condition of the government or anything other than the interests of that person.  Unless that is our attitude I believe that the ethical and moral foundation of our profession will be lost. I don't really believe that the third parties are ill-intentioned but at the same time their interests do not always coincide with that fundamental  relationship between the patient and the doctor.  And I believe that the primary role of organized medicine should be to protect that relationship and in doing so it is protecting the interests of the doctors in the most fundamental way.

The third party bureaucracy and health care planners are never going to change course of their own volition. If things continue as they are going the practice of medicine is in for some tough times. Some think the cure for our sick system is just for the government to take over everything but to my mind that treatment would amount to sending the patient to the hospice unit. This approach would leave us in the  hands of the most oppressive third party of all. I believe that the only real answer to this situation is to do what Timothy Leary used to say back in the '60's, that is to TURN ON, TUNE IN and DROP OUT. There is a tiny but  growing movement of physicians who have become frustrated with the system  and are doing  just that, dropping out from government plans and insurance, and this has been going on especially in the large urban and rural areas. That could be the beginning of a movement or just a flash in the pan. I suspect that it's going to spread because it's pretty clear that doctors are in for a future of increasing overhead costs, decreasing reimbursements and increasing outside  interference with medical practice.

The real key is whether  patients will drop out  too and I am encouraged in this regard by the rapid growth in the use of health savings accounts in the last few years. If more patients begin to have high deductable insurance and pay ordinary expenses out of pocket,  doctors and medical facilities with low overhead  who post their  fees and give more personal attention will be more attractive. I belong to a medical association one of whose activities is to help physicians to develop successful  practices free of insurance and government and those who do it report that they are making a respectable living and enjoying practice much more and that their patients like it more too. If I were 40 or 45 again in the present practice environment I would be very tempted to try it. Who knows.  In due time, I just might.

 



[1] http://www.physiciansfoundation.org/healthcare-research/a-survey-of-americas-physicians-practice-patterns-and-perspectives

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