The death of the doctor-patient relationship?

In July 29th's New York Times, a dismal article highlighted the decline of the doctor-patient  relationship this way (you may have to sign up for free to access the article):

'About one in four patients feel that their physicians sometimes expose them to unnecessary risk, according to data from a Johns Hopkins study published this year in the journal Medicine. And two recent studies show that whether patients trust a doctor strongly influences whether they take their medication.

The distrust and animosity between doctors and patients has shown up in a variety of places. In bookstores, there is now a genre of “what your doctor won’t tell you” books promising previously withheld information on everything from weight loss to heart disease.

The Internet is bristling with frustrated comments from patients. On The New York Times Well blog recently, a reader named Tom echoed the concerns of many about doctors. “I, as patient, say stop acting like you know everything,” he wrote. “Admit it, and we patients may stop distrusting your quick off-the-line, glib diagnosis.”'

This hostility is not new, but it has never been quite as publicized as now, with such easy access to the Internet. A negative blog post, a denigrating comment on a health rating site - physicians are soft targets for bitter skewering and spiteful revenge from disenchanted patients.

What has happened?

What have we done to deserve this suspicion and, at times, even vitriol?

All of us know of patients who "don't know why they got referred - their doctor just told them to come". And we have all heard horror stories of the wrong side being operated on. But come on, this isn't new!

I really don't know the answers, but I can speculate on a few reasons for this state of affairs:

• Doctors' burnout is contagious. Angry doctors impart their frustration in both conscious and unconscious ways. And patient antennae pick up the vibes, and take it personally.
  
  
• There really just ISN'T enough time. Stress and pressure can make anyone forgetful. Communication skills suffer when you are anticipating the next onslaught of patient problems instead of focusing on the patient right there in the room.
  
  
• There isn't enough support. Many of the items that need to be communicated with patients are routine, and lend themselves well to systemization. However, it takes time to develop the systems that a well-oiled practice depends on. This means that valuable physician time, that could be spent on the highly personalized conversations, is consumed instead with minutiae that electronic or lower-paid professionals could handle.
  
  
• Residents don't get taught well. They are too busy, absorbing the overwhelming amounts of information they need these days. Perhaps there is no longer the time to truly focus on building effective, trust-generating doctor-patient relationship skills.
  
  
• Too much technology. Are we being misled into believing that technology is medicine's best friend? Perhaps it's time to go low-tech again ... really get up close and personal with a good history, a stethoscope and our hands instead of rushing to order a CT-scan or a lab panel.

Do you have any thoughts on this distressing topic?

What are some of the solutions?

Getting your entrepreneurial physician "Message" clear

I am increasingly convinced that true entrepreneurial success for those physicians who embark on a business venture or a new practice hangs on mastering one key action - getting crystal clear about your "Message".

Confused? Maybe a brief personal story will help.

As a family physician, I treated all comers -- all conditions, both genders, all ages. However, without paying attention to my own practice's evolution, I began spending more and more time with perimenopausal women, ranging in age from about 45 to 55. I loved exploring their experiences, their circumstances, their challenges. I enjoyed trying to find helpful solutions to their physical and often mental and spiritual discomforts. In many ways, it was the genesis of my interest in coaching!

I had unknowingly developed a niche.

And had I had half the insight I have today, I might have spent some thoughtful time crafting a Message to these prospective and actual patients. It might have gone something like this:

"I bring my most caring and daring bedside manner to help women in their late 40s and early 50s find meaning in their lives, while relieving many of their physical, emotional and spiritual discomforting symptoms."

I would have lovingly crafted an entire "sub-practice" experience and set of solutions, both services and products, for this ideal target market of mine. I would have used all of the resources available then to position myself as an Expert. And I would have morphed into today's era by creating information products (audio and video, as well as written), forming affiliate relationships with providers who offer services that complement mine (those I chose to "buy" rather than "make"). I would have started a blog, written a book, found a way to be on Internet radio as an Expert and Trusted Advisor, and tried to catch the eye of mainstream printed and TV/radio media. I might even have aimed to be on Oprah!

And I might even still be in practice today, loving the business I could have intentionally designed and delivered.

No matter what your business, your winning strategy starts with uncovering your unique gifts, your passions and interests and the target market you are naturally drawn to serve. You can no longer afford to be a generalist without a compelling message as to why your preferred clients or patients should choose you!

Once you have a clear business model and plan, your most effective marketing strategy evolves as simply a matter of finding your "Message", spoken with conviction from your heart to a ready, listening audience!

A focus on the Positive

In a spirit of lightheartedness, let me offer two items today.

One is The Plain Dealer columnist Regina Brett's 45 Life Lesson's and 5 to Grow On - one of her most widely-read articles. I appreciate her upbeat, pithy approach, and have listed my favorites:

2. When in doubt, just take the next small step.

4. Don't take yourself so seriously. No one else does.

10. When it comes to chocolate, resistance is futile.

11. Make peace with your past so it won't screw up the present.

13. Don't compare your life to others'. You have no idea what their journey is all about.

17. You can get through anything if you stay put in today.

19. It's never too late to have a happy childhood. But the second one is up to you and no one else.

20. When it comes to going after what you love in life, don't take no for an answer.

25. No one is in charge of your happiness except you.

26. Frame every so-called disaster with these words: "In five years, will this matter?"

29. What other people think of you is none of your business.

37. Your children get only one childhood. Make it memorable.

41. Don't audit life. Show up and make the most of it now.

43. All that truly matters in the end is that you loved.

50. Life isn't tied with a bow, but it's still a gift.

To enjoy the rest, read here.

The second gift I have for you is Dr. Martin Seligman's video on The State of Psychology from TED Talks (for those unfamiliar with the series, you are and doers).

Dr. Seligman is a former president of the American Psychological Association and is widely considered the father of Positive Psychology. Although the video is now 4 years old, the content still seems relevant and appeals to my fascination with how humans achieve their highest potential.

I hope these items enrich your day!

Is time running out for healthcare reform?

I stay away from political and philosophical debate about healthcare unless it has direct impact on our lives as entrepreneurial physicians. I just don't have the time to spend on that level of reflection, much as I would enjoy it.

However, once in a while, I come across writing that is both thought-provoking and good, such as this blog post by Brian Klepper, from the Health Care Blog.

Since I read it from beginning to end and found it fascinating, I'm offering it to you - a busy MD - in the hopes that it may stimulate your entrepreneurial thinking.

And if it's not a partial creative solution you're able to come up with, then at least you will have better insight into the environment in which you are practicing, working or operating your business. It may help you make some important decisions. Alternatively, it may just depress you!

Physician Medicare payments in turmoil

As most of you probably know by now, Congress voted last week to override President Bush's veto of the Bill that proposed an 11% cut in payments to doctors taking care of Medicare patients.

Two articles I read today had me wondering what physicians are going to choose regarding Medicare, despite the short-term relief. Because I sure don’t know how I’d handle this if I were still in practice and accepting Medicare!

Article #1, titled “Leaving Medicare is Easier Said than Done” written by Elias Bakhtiari of HealthLeaders Media cautions against being too flippant about quitting the Medicare program.

He writes:

‘In fact, completely opting out isn't as good of an idea as it might seem, says healthcare lawyer Randi Kopf, RN, MS, JD. Physicians who officially opt out must file a formal affidavit and can't participate for a two-year period. During the opt-out period, neither the physicians nor their patients may submit any claims for payment to any Medicare carrier. If the patient forgets and submits a claim, it could raise a red flag and trigger an audit.

"A lot of practitioners think they can easily opt out," Kopf says. "If they don't do it properly, they're going to be violating regulations. There are too many hazards."’ (emphasis mine)

Bakhtiari offers 4 questions to consider before making your best decision re complete opt-out OR non-participation:

1. Are you considering dropping all insurance?
2. Does the compensation you receive for participating allow you to practice medicine comfortably?
3. What percentage of your practice has Medicare as their primary insurer?
4. How many staffers do you having managing and filing insurance claims?

 Article #2 from the New York Times, with the enticing title of “Trying to Save by Increasing Doctors’ Fees” addresses new experimental moves by insurers to encourage the creation of Medical Homes – and pay up for providing good care.

“The idea is that by paying family physicians, internists and pediatricians to devote more time and attention to their patients, insurers and patients can save thousands of dollars downstream on unnecessary tests, visits to expensive specialists and avoidable trips to the hospital.”

What a novel idea! Forgive my sarcasm but I want to shout “Duh … does someone finally get it!"

Here are some of the ideas from the article:

“Earlier this month, as part of a bill to protect Medicare payments to doctors, the Senate overrode President Bush’s veto to authorize $100 million to finance a three-year Medicare pilot to further test the concept of spending more on primary care.

Under the various payment experiments, family doctors are encouraged to hire additional staff to help monitor patients’ treatment and follow-up, and to help patients stay ahead of problems by sending reminders when they are due for preventive tests like mammograms and colon exams….

… The panel has recommended that Medicare expand its plans for a medical-home pilot project next year that is expected to pay primary-care doctors in eight states $30 to $40 a month extra for each person enrolled with a chronic illness.”

I’m not surprised the big insurers are skeptical – although they stand to gain from the savings. But they seem to be doing well enough from the status quo – so I guess their reasoning is why mess with what is currently nice and profitable?

So, do you drop Medicare or hold out for an improbable influx of much-deserved money?

What would you choose?

Update on Tuesday, July 22, 2008 at 10:06AM by Philippa Kennealy

It seems Medicare is rushing to catch up with the times - take a look at this article today on e-prescribing, and how Medicare intends to incentivize its use, in the Washington Post.