Three factors that can make or break the physician-patient relationship

For better or worse, medicine has evolved from a culture of "doctor knows best" to one of patient-centered care. But not all physicians or their patients have hopped on the pendulum and swung to the other side. While a suspected majority of patients want to be active decisionmakers in their care, a number of others just want their doctors to tell them what to do, says Alan Christensen, PhD, professor of psychology in the University of Iowa College of Liberal Arts and Sciences and of internal medicine in the UI Carver College of Medicine, whose research appears in the May issue of the Journal of General Internal Medicine.

Using surveys and prescription refill records, the study concluded that when physicians and patients are of the same mindset regarding the balance of control, patients are more likely to take their prescribed medications.

If doctor and patient attitudes were in sync, patients only let their refills lapse about 12 percent of the days in the 13-month study period. But if patients held higher control beliefs than their physicians, they went without their pills 18 percent of the time. The study also found evidence that patient blood pressure may be less well maintained when doctor and patient control beliefs do not match.

"Patients who held high personal control beliefs about their health were 50 percent less likely to adhere to their medication regimen if they were being treated by physicians who didn't share this belief in strong patient control," Christensen said, adding that patients may react to getting less control than they want by not following a doctor's orders.

Christensen recommended that physicians tailor their approach to individual patients' attitudes and desires for control, which many physicians report they already do.

On the physician side, 72 percent of respondents to a survey by Jackson Healthcare reported that the practice of defensive medicine negatively affects patient care. Sixty-seven percent reported that defensive medicine harmed the doctor-patient relationship.

Additionally, 75 percent of respondents believe defensive medicine will decrease the number of physicians in the United States, perpetuating an existing physician shortage, and 87 percent of current residents and fellows reported that they were taught to practice defensive medicine, reports Renal Business Today.

A recent survey of cardiologists indicated that 24 percent of heart doctors perform medically unneeded tests out of fear of being sued.

And for this specialty and others, the advent of the medical home poses yet another complication in the doctor-patient dynamic. The movement, some argue, directly or indirectly takes funds that would have gone to specialists and funnels them to primary care, according to an article in today's New England Journal of Medicine.

The piece goes on to question whether the many specialists--such as urologists, cardiologists and endocrinologists who see patients frequently to manage chronic diseases--can or should be able to serve as a medical home.

"It would be excessively rigid to prevent specialists who want their practices to serve as medical homes from pursuing this goal," the authors stated. "But specialist-based medical homes should be required to meet the same standards as primary care-based medical homes, including the requirements for providing first-contact,continuous, and comprehensive care and for using systematic processes to improve the health of the practice's patients."

To learn more:
here's the New England Journal of Medicine article
- read this piece in The Medical News
- check out this Renal Business Today article
- here's a summary of the  Jackson Healthcare findings

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