A couple of weeks ago I attended a local meeting on the future of primary care. It was one of several that were hosted around Minnesota this past month to gather ideas and perspectives on the issues surrounding primary care.
On many levels, the discussion was truly depressing. Among the concerns I heard: There’s too much paperwork. Aging and chronic disease have made patient care much more complicated. Doctors are overburdened and dissatisfied. The primary care workforce is shrinking.
There was some talk of potential solutions, such as bringing in scribes to reduce the burden of medical charting or finding ways for physicians’ work time to be more flexible.
But what I didn’t hear was where patients might fit into all of this.
For better or worse, there’s a lot of frustration in health care these days. Consumer Reports recently published the results of an online survey of 660 doctors and the findings are revealing:
- 70 percent of the respondents said they were getting less respect and appreciation from their patients.
- The top complaint was failure by patients to follow advice or treatment recommendations.
- The volume of insurance paperwork was the No. 1 barrier to providing optimal care, followed by financial pressures that force doctors to see more patients for shorter visits.
If health care providers are frustrated, so are patients. Consumer Reports also surveyed 49,000 of its subscribers and found that although the majority were very satisfied with their doctor, they were less so if they felt their doctor rushed them through a visit, dismissed their symptoms or were too quick to whip out the prescription pad.
By now you’ve probably connected some of the dots. No one’s happy with short visits, unappreciative patients, harried doctors or tons of paperwork. Whether we realize it or not, patients are deeply enmeshed in what ails primary care, and if the ship is going down, patients are going down with it.
It’s all the more unfortunate, then, that many of the so-called solutions to primary care often are formulated and implemented with little, if any, input from patients. Take medical scribes. On the surface, it sounds like a great idea: someone who can take over the burden of charting and documentation so the doctor can concentrate his or her attention on the patient. But how do patients feel about this? Will it change the dynamics of the encounter? It’s one thing, after all, to have someone transcribe the doctor’s notes after the visit; it’s quite another thing to have a third person in the room, during real time, taking notes on the visit.
Evaluations of demonstration projects to implement the medical home concept found that patient satisfaction actually eroded. Assumptions that patients don’t mind having their care turned over to mid-level professionals also can be mistaken.
For what it’s worth, I think patients and doctors still value the relationship-building that lies at the heart of primary care. In fact, when the Consumer Reports survey asked doctors what patients could do to obtain better medical care, establishing an ongoing relationship with a primary care doctor was at the top of the list.
Unfortunately the ability to form and sustain those relationships is being seriously fractured by multiple pressures from the outside. There’s a very real danger that in the rush to come up with solutions, we overlook or devalue what makes primary care unique, what draws physicians to primary care in the first place. Who benefits from that? Not physicians, and certainly not patients.
This is a discussion in which patients need to participate. I hope someone out there is listening.
Photo: Wikimedia Commons