Physician patient relationship: Event highlights

Highlights from the NYC Health Business Leaders panel: The Physician Patient Relationship: Strategies to Increase Engagement & Improve Outcomes

physician-patient-relationship

Cropped image of depressed man at the psychotherapist. Doctor is making notes while listening to his patient

Here are some ideas that stood out during the recent NYC Health Business Leaders panel discussion. Please note this is my completely unofficial point of view, and may not reflect what the panelists intended!

Making patient wait time efficient

  • If a patient visits a physician once, they will typically see their physician 5–10 more times that year. An average of 20 minutes is spent in the waiting room before the appointment, compared with 15 minutes actually spent with the physician.
  • One approach is to utilize time spent waiting to make the physician-patient encounter more efficient. Using technology such as tablets, providers can collect and/or offer actionable data while patients wait.

For example, they can:

  • Identify depression symptoms
  • Present information about the patient’s condition
  • Educate patients on the right questions to ask about their condition when seeing their physician.

The problem with technology

  • Empowering patients to ask the right questions leads to longer encounters with their physician, which is not reimbursed. A dialogue takes time!
  • Recent studies show that technology can get in the way of treating the patient. For every hour that physicians devote to direct patient care they may spend about five hours on computer work.

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Shared decision making is not a panacea

  • Shared decision making is a key component of patient-centered health care. It is a process in which clinicians and patients work together to make decisions and select tests, treatments and care plans based on clinical evidence that balances risks and expected outcomes with patient preferences and values.
  • Shared decision-making does not start with the patient – it starts with provider culture. But most physicians are not trained in shared decision making, so they are ill equipped and sometimes unwilling to engage their patients in this way.
  • It’s most appropriate where there are options of roughly equal value, such as prostate cancer. Right now, it is more aspiration than reality.
  • Often the best time for a patient to think about their treatment options rationally is between visits, not in the stressful environment of a physician’s office.

Physician patient relationship: Why 15 minutes?

  • The providers on the panel all struggle with the constraint of a 15-minute physician encounter. Often this is inadequate and leads to patient dissatisfaction, not to mention compromising adherence and outcomes. In other cases it inhibits the use of care teams, where care delivery may not fit into a rigid framework. It’s hard to believe that the 15-minute encounter – a concept that sounds like a mechanistic relic of the factory floor – is still a key part of a modern healthcare system.
  • Great idea! If physicians had more than 15 minutes, they could review their senior patients’ prescription record and de-prescribe unnecessary drugs.

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