For some, it may seem strange to think of the doctor-patient interaction as a relationship. In the most basic sense, a relationship is a connection; it is how two or more people or groups regard and behave toward each other. Relationships are not static – they are influenced by an ever-changing social, cultural, and political environment. They must try to adapt or risk tension and strife; the doctor-patient relationship is no exception.
Modern primary care has evolved such that the customary assumption – that one doctor will singlehandedly manage the comprehensive needs of a large patient panel – is no longer sustainable. Doctors, now almost equally men and women, many of whom are parents of young children, face an infinite stream of patient portal messages, insurance pre-authorizations, documentation and coding requirements, paperwork, and ever-changing formularies – intrusions that are pushing work deeper into personal time. Patients are stressed over diminishing access to primary care and confusion around ever-expanding care teams.
Complexities in primary care delivery have inspired new ways of working. There are impactful things we can do right now to update and reset the doctor-patient relationship for current times. For one, doctors can refine our communication skills to create richer connections and feel a stronger sense of meaning in work. A clear, empathic conversation will also help doctors set availability limits, discuss visit agendas and introduce patients to new practice processes that best meet their needs and preserve our resilience.
Another vital charge for doctors and patients is fully embracing team-based care. This paradigm shift contrasts with an ingrained tradition of the personal physician and is essential to modern primary care practice. One doctor cannot do justice to the simultaneous demands of in-person practice and asynchronous tasks within the doctor’s digital in-basket. Too many attempts to do so have resulted in emotional exhaustion and substandard care. The only sensible solution is to share these duties with an adjunct group of professionals functioning at the top of their licenses. Diverse patient voices in team-based care must also be amplified through more engagement with patient family advisory councils (PFACS) and seats at the table for other health system change initiatives.
Patients are unlikely to feel great pity hearing doctors lament about long hours, excessive tasks, and burnout. In most of their eyes, we are highly paid professionals who should somehow manage. That said, doctors must take the lead and demonstrate how new ways of working can help patients meet their needs more reliably and efficiently. Clinicians with good work-life balance are happier, more empathic, and less error-prone.
If there was ever a true agility test of patients’ and clinicians’ capacity to reset outside of a total health care overhaul, it has been the COVID-19 pandemic. The changes currently driving the need for a longer-term upgrade of the doctor-patient relationship are less dramatic than COVID-inspired adaptations. Certainly, they do not obviate the critical need for an overhaul of the financing and delivery of primary care. But they are as profound, of comparable urgency, and eminently doable.
Jeffrey H. Millstein is an internal medicine physician.
