When I choose to call this blog “The Treating Physician,” I was attempting to remind readers that health care decisions should be the province of the patient and the physician. Indeed, that was the crux of the book Dr. Lindemann and I wrote 20 years ago, Modern Medicine: What You’re Dying to Know.
Currently, there is much interest in trying to bring down the cost of health care by reviving this relationship. Dave Chase has written of the need to regard patients as active members of the care team instead of just something to hang diagnostic codes on for reimbursement in “Patients Are More Than a Vessel for Billing Codes.” This is good news. The bad news, though, is when the conversation turns, as it does in some places, to somehow measuring patient satisfaction so as to relate that to physician reimbursement.
As I posted in “Surveys, Smurveys: Who Do They Think They’re Kidding?” there is much that can be gained in examining the physician-patient relationship, even using surveys to measure patient satisfaction. But to then try to tie survey results to patient reimbursement is a travesty. Surveys, even good surveys, can produce good information for finding out what people feel or think—but the operative words here are feel and think, that is, opinion.
Opinions do not have to have any basis in fact at all. The information garnered from surveys may be valuable for planning purposes, for finding out what people think, but they are most definitely not factual enough to then turn around and make physician reimbursement dependent upon those survey results under the pretense that opinions factually represent quality of care.
Instead of trying to measure the value of the physician-patient relationship based upon collected opinions, we should be concentrating on how to measure what the patient gains by a renewed understanding of how that relationship improves quality of care.
In days past, people usually had a family physician who took care of most of their needs, with trips to specialists now and then. That primary physician knew the patient, probably knew the patient’s family, and would usually keep an eye on the big picture, keeping the loose ends of patient care in tow.
Now most people have fragmented health care, with no one physician in charge of a patient’s overall care. From the unknown physician in the walk-in clinic to the specialist on a “team,” the patient has no one person able to sit down and discuss the whole gamut of care options across many disciplines, and help the patient make choices that work best for the patient across however many health problems the patient may have.
My concern is the loss of this physician-patient relationship, a relationship which helps a patient understand the framework of the decisions he or she makes about their health care across many specialties.
In this blog, drawing attention to this physician-patient relationship is my intent in using of the term treating physician. Many people today have never known such a relationship. Medicine is the poorer for this lack, as is certainly the health care of every single patient.