Closing the doctor-patient gap on communications, finance

It lasted for just a few minutes, yet its memory will endure: The pediatric specialist pedantically describing what asthma was and why my daughter would suffer from it forever.

There was no acknowledgement I had a college education and nearly 20 years as an adult under my belt. There was no attempt to gauge my native intelligence as either a parent or human being. There was no effort to solicit my thoughts.

Nor did the doctor contemplate the possibility that after 13 months of breathing China's decidedly colorful air before being brought to the U.S., my daughter Mia's congestion might eventually subside.

Fortunately, my wife and I do what we normally do when people refuse to engage us on a level plane: We ignore them. A decade later, we don't budget for inhalers and face masks. Mia only gasps for air when asked to clean her room.

I'd say this type of disengagement between doctors and their patients was an exception, but I could write several columns about misdiagnoses, urgings to undergo expensive tests and literal harrumphing when a doctor's edict was questioned or more information requested.

So I wasn't surprised about the recent Mayo Clinic study concluding doctors believe their patients bear more of a responsibility for controlling healthcare costs than they do, and by a wide margin. Only 36 percent of doctors believe they bear that responsibility, but 52 percent of them think their patients do. Only trial lawyers and insurance plans--neither of whom are actually present when diagnoses are made, care is provided and drugs are prescribed--bear a larger responsibility than the patient, according to doctors.

And while a large majority of doctors believe they should try and discourage pricey tests and care, less than 10 percent wanted to do away with fee-for-service reimbursement.

It therefore appears doctors are more than willing to pass the buck when it comes to cutting the price of healthcare. That is, unless an actual buck is involved--in which case they'd like to hold onto it, thank you very much.

Such attitudes are hardly helpful for the finances of hospitals, particularly as RACs and other entities continue to drill down on big cost centers.

But hospitals do have one form of leverage: The physician as employee. As a variety of studies have shown, more and more physicians are being hired by hospitals and healthcare systems as employees, particularly as the accountable care organization model takes greater hold. The recruiting firm Merritt Hawkins predicted last year that as many as three-quarters of the nation's doctors will be employed directly by hospitals by next year (although states such as California, which prohibit direct physician employment by acute care facilities, may be the exception).

Given the overall disconnect between doctors, patients and their finances, hospitals hiring doctors should consider orientation sessions that do more than explain the benefits these new employees will receive. They should include intense workshops and retreats on how to define the physician-patient relationship to open up communications and understand why it would assist in providing cost-effective care. If docs balk, create an incentive: Lobby the appropriate agencies to make such communications workshops part of continuing medical education requirements.

If doctors truly believe that patients are responsible for controlling costs while they are actually the gatekeepers of care, an end of an era may be near. It would mean their word is no longer absolute. It would also mean the buck actually stops somewhere. - Ron (@FierceHealth)

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