Patients and doctors need one another now more than ever

To the patients concerned about the future of health care:

We need one another now more than ever.

In April last year, I started this blog to help patients and physicians connect in an increasingly disconnected health care system. Both patients and physicians feel bound and invaded from multiple directions, all interfering with the doctor-patient relationship. We all suffer for it.

It occurs to me that many of you may not know exactly what we physicians struggle with that makes some of us so grumpy every day.

What assumptions do you make about us, and how does that impact our interactions?

Here are just a few of our challenges:

Electronic health records. You’d think this would make everything faster, easier. It has not. It’s not only your chart. It’s your billing record. It’s the demographic, biometric, diagnosis, treatment and outcome data repository. And it’s clumsy, to say the least, at all of its functions. Read more about how it negatively impacts physicians’ quality of life and care.

Quality measures. We all want you to have the best quality care possible. But how do we measure that? Many payers base it on outcomes. Physicians are judged and compensated, for instance, based on their patients’ blood pressure, blood sugar and whether or not they have quit smoking. But I cannot control these things. I cannot make you take your medication or stop eating sugar. I cannot make you stop smoking. What I need is to talk to you about your life so that we can figure out the solutions.

Quantity pressure. But talking requires time — quality time. The 15-minute clinic slot is designed to maximize volume, not quality (how ironic). If you have an acute problem, on top of your uncontrolled blood pressure and diabetes, and we also have to set up your mammogram and colonoscopy, how can I possibly have time to explore, let alone address, the nuances of your health behaviors?

Some of my colleagues advocate for policy change at state and federal levels. When I suggest that we consider bringing patients on board to help advocate for/with us, some eschew the idea. We advocate for our patients, not the other way around, they say. It’s as if we will be seen as weak that we bring you along to speak on our behalf.

The way I see it, we should all stand and speak up for one another. Yes, in our working relationship I have more power and authority in many ways, and it’s my job to take care of you. But we are all participants in the larger system, and I think we can make greater, faster change for the better if we all fully understand our shared interests and goals, and advocate for them side by side.

What else do you need to know?

Catherine Cheng is an internal medicine physician who blogs at Healing Through Connection.