As often happens in a given issue of FiercePracticeManagement, we have two top stories that appear to be at odds. On the one hand, we have new research published in the Journal of the American Medical Association supporting the idea that paying physicians cash to hit certain quality metrics improves patients' health (cardiovascular, at least). Meanwhile, we featured a poignant Boston Globe article written by resident physician Joshua Liao, M.D., describing the importance of preserving the "intangible rituals of doctoring"--namely listening, reassuring and connecting with patients--amid the pressure to obtain quantitative proof of success.
"Numbers are indeed important," Liao wrote. "Our increasingly interconnected societies and sophisticated technologies generate massive amounts of data. The management and analysis of all this information has revolutionized business, politics, science, public health, and social research. As momentum builds, those of us in clinical medicine now find 'big data' knocking on our doors, promising to revolutionize our profession as well."
But to Liao's ultimate point--and one I've fumbled around trying to make myself--the physician-patient relationship trumps check-boxes every time. I'm not a doctor, but it seems obvious to me, for example, that trying to get a patient to quit smoking without an understanding of what stressors make them cling to cigarettes is putting the cart before the horse.
As a science-minded person, I appreciate data, evidence and research. If pay-for-performance helps my mom get the tests and interventions she needs, bring it on. She is a prime example of an over-65 individual with numerous issues to tackle. Like with a lot of patients targeted by existing P4P programs, a checklist is absolutely necessary to ensure every aging, sometimes-neglected organ and body system is addressed.
My mom is also in many ways the patient I described last week who will benefit most from being part of an ACO. For many years, she was the patient the doctors didn't see. She and the healthcare system were mutually out of sight and out of mind, until the day she wound up hospitalized for a stroke (from which I'm thrilled to report she's made a full recovery). It is not the system's fault that her health reached a crisis point before calling her back; but I have no doubt that more formal care-coordination (i.e., professional, systematic, relentless nagging) could have helped a great deal.
At the same time I see her--vividly--in the patient described in Liao's piece. She needs to be heard before there is any hope that she will listen. Though I'm using only two anecdotes to draw from, I don't believe this experience is rare.
I don't have to tell you that practicing medicine is both an art and science. One of my roles in writing these columns is to bring you insights into how to continuously improve at both. Liao offered some tips to increase your efficiency in order to preserve more quality time with patients. And as a daughter, mother and fly on the wall, I urge you to try them out.
Be patient with your patients. To throw in a running analogy too fitting to resist: Build your base. Much like you can't go run a marathon without training your legs to endure greater distances over time, you can't skimp on the time it takes to truly connect with patients and expect them to change in meaningful ways. They might sprint to quick improvements to help you reach your numbers, for example, but in a year's time could be right back to their old ways if the root issues aren't addressed. To succeed in the long run--pun intended--your relationship needs miles on it. The stronger it becomes, the harder you can push, and the more miraculous the results, qualitatively and quantitatively, you will achieve. - Deb(@PracticeMgt)
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