You the patient are really not the
customer of your primary care physician. Since the insurer will determine whether and how
much the physician will be paid for attending to your needs, you are largely a
bystander in the relationship. The doctor’s customer has become the insurer.
Our system of care is definitely not
customer-focused. Doctors truly believe that they have the patient’s best
interests in mind and they do. But their work is not customer focused as it is
in most other professional-client relationships. You wait long weeks and
sometimes even months for an appointment (the national average is 20.5 days),
spend long times in the waiting room and are frustrated that you get just 10-12
minutes with your doctor who interrupts you within less than a minute and who
recommends you see a specialist but does not personally call the specialist to
explain the issue nor to smooth the path for a speedy appointment. All of this
because, in the case of primary care, the doctor must see 24-25 patients per
day to meet overhead and achieve a personal income of about $170,000.
As for the insurers, you are not
their customer either. Their customers are the ones who pay them - your
employer or your government. And it
shows – by our long waits on the phone, by the complex, often hard to
understand paperwork and by the frustration when the insurance you thought you
had does not cover your latest tests, x-rays or specialist visit.
So you are not the insurer’s
customer nor are you the doctor’s customer. You are a mere bystander. This is
hardly the type of contractual relationship you have with your lawyer,
architect or accountant. In those situations, you pay them directly. Want more
time? No problem, but you pay for it. Want telephone consultation? No problem,
but you pay for it. Not so in medicine. You the patient cannot decide and ask
for more time or ask to use of email or telephone. Because you are not paying
for the time and your insurance will not do so either. It is just not your
choice.
To be clear. Yes, you are paying the
physician directly in the co-pays and the deductibles but it is still the
insurer that determines whether and how much the physician gets paid. You just get
to contribute whatever portion you are told.
Who is to blame for the current
state of affairs? Each party looks to the other but perhaps each should hold up
a mirror and take a close look. Nevertheless, here is what physicians think
based on a recent survey. Ninety per cent say the medical
system is on the wrong track; 83% are thinking about quitting; 85% think the
patient-physician relationship is deteriorating; 72% do not think the
individual mandate will lead to improved care; and 70% think that the single
best fix would be reducing government intrusion. Further, 49% will no long
accept Medicaid patients and 74% plan to stop accepting new Medicare patients.
Finally, 80% believe doctors and other medical professionals are the most
likely to help solve the mess.
So the paradox is that America has
the providers, the science, the drugs, the diagnostics and devices that are
needed for outstanding patient care. But the delivery of health care is truly
dysfunctional. What is needed is fewer patients per PCP so that each gets the
time and attention really needed. The PCP needs time to listen, to prevent, to
coordinate chronic care and time to just think. This means increasing not
decreasing the cost of primary care per person. An increase in costs, yes, but
an increase that will dramatically lower the total cost of care. More effective
preventive care. More attention to the complex chronic illness with fewer
referrals to specialists. Better coordination
of the care of those with chronic illnesses, enhanced prevention such that many
chronic illnesses don’t develop. Spending
the time to listen and become trusted as the healers that they could and
should be -- all leading to better care at much lower total cost.
A new vision for our system must
make it a healthcare not just a
medical care system. It must recognize the importance of intensive preventive
care to maintain wellness. It must address the needs of those with chronic
illnesses to both improve the quality of care while dramatically reducing the
costs of care. And it must be redesigned so that the patient is the customer
that he or she should be. And, critically, to make it work effectively, America
needs many more primary care physicians – they are and should be the backbone
of the healthcare system – who are able to offer outstanding preventive care,
care for the vast majority of complex chronic illnesses, offer coordination for
those with chronic illnesses and do it in a manner that is satisfying to doctor
and patient alike – with true healing along with expert medical care. It’s
doable but it means a rethinking of how our delivery system is structured and
assuring that PCPs have fewer patients for more time each.
It is possible but it will require
both doctor and patient alike to demand it. There are many ways to skin the cat
but the most promising is direct primary care (membership/retainer/concierge)
practices. More on this later.
My next post in this
series on the crisis in primary care will be about today’s impediments to good primary care.
1 comment:
A medication that can enable you to evade attacks of anxiety, uneasiness, and a resting issue,
is accessible to purchase without prescription at UK Napping Pills.
See More : https://ukmeds247.com/product/diazepam-10mg/
Post a Comment