The healthcare system is getting worse, and a big reason is that the doctor-patient relationship is no longer being prioritized.
In planning your healthcare team, I would argue the most important first step is choosing the right primary care doctor. Your primary care doctor (or PCP) is the quarterback of your healthcare team. If you were to have a major illness, you want someone who knows you guiding you through the system and helping to call the shots.
The Doctor-Patient Relationship: The Ultimate Guide
In this guide, I'm going to tell you about what the doctor-patient relationship used to be like. We'll review the literature (and the common sense) behind the benefits of a wonderful relationship with your primary care doctor. Finally I'll offer some practical tips to help you find a doctor that's the right fit for you.
What Happened to the "Old-School Family Doctor"?
Maybe you have experienced this phenomenon, or heard your parents or grandparents talk about "their doctor." It usually goes something like this: "Dr. X took care of my whole family for 30 years. He knew me so well, and he would always get me in to be seen if something came up. He really took the time to listen, and because of that I trusted him and knew I could depend on him. I was devastated when he retired."
How often do you hear someone bragging about their doctor like this these days? Sadly, medicine has changed so much - I blame insurance companies and hospital systems. The focus is now on "volume" and "productivity" rather than actual quality of care. Even the "quality metrics" that they love to track have nothing to do with time spent with patients, how well patients feel understood and respected by their doctor, or whether patients feel that their health concerns have been adequately addressed.
I know personally, as a mom, I know when I take my kids to the pediatrician that marking their BMI in the chart is a quality metric. But I'd find it much more meaningful to have a thoughtful discussion about my son's eating patterns and activity level than to have a number documented. Fortunately, my son's pediatrician is excellent, but now doctors are under pressure to provide amazing care, but ALSO do it in 15 minutes, and THEN spend about 15 minutes clicking boxed in the electronic chart to "prove" they did their job. So what's slowly getting phased out is the amazing care and communication that used to be a standard in medicine.
Another thing that was exceptional about your grandma's "old school family doctor" was that he would always see her when she was in need. She could call him directly if she had a problem. Or if she was really ill, he would even come out to her house to check her out. Nowadays hospital systems prioritize scheduling brand new patients over patients that are already patients of that doctor! I can't count the number of times in my previous jobs that my patients called for an urgent issue, only to be told I couldn't see them for months. At that point they would either get shuffled around to another doctor or nurse practioner or warm body, or told "if you're concerned, you should go to the ER." That's awful care, and the job of the ER doctor is to rule out life-threatening issues, not treat ailments that can be managed by the patient's regular doctor. It's a disservice to patients and a misuse of the healthcare emergency system.
We know it's unacceptable, and that's why more and more doctors are pushing back by opening their own practices and operating without the rules and restrictions of insurance companies. I digress, but you can read my own story in "Why Did You Start Emerald DPC?"
The Benefits of a Great Doctor-Patient Relationship
As patients we intuitively understand the benefit of a great relationship with a primary care doctor that knows us very well. But surely if the hospital systems aren't prioritizing your access to your own doctor, it must not be a big deal, right? WRONG. Let's look at what multiple studies have shown the benefits of a great continuity of care relationship to be.
Improved patient satisfaction
More accessible healthcare
Reduced ER visits and hospitalizations
Lower healthcare expenses
Increased use of preventative care
Better patient adherence to treatment regimens
Decreased risk of mortality
Improved doctor satisfaction and decreased rate of burn out
So, in short: happy patients and doctors, better care, and less time in a hospital or ER.
How to Figure Out if a Doctor is the Right Fit
Okay, so we now know that it is possible to have a great "old school" doctor that provides great care and knows your family like the back of his/her hand. We like living longer and being healthier, and spending less money on healthcare. Now how do we go about finding this unicorn?
1) Get recommendations from friends and family.
Who loves their doctor? Who can actually see or talk to their doctor when needed? Personal recommendations are a great place to start.
2) Look for direct primary care, concierge medicine, and private practice doctors.
Why? Because we're more in control of our practices. Our patients aren't battling with centralized scheduling for an hour to get an appointment. We have control over our schedules and plan for times to see our existing patients when they're sick.
Direct primary care doctors have the most autonomy because A) they aren't part of a hospital system with its own financial agenda, and B) they aren't contracted with health insurance companies who are incentivized to deny/delay care. Most direct primary care doctors own their own practices, and they care about their small business having a great reputation and functioning smoothly.
Concierge doctors area also independent from hospital systems, but they typically contract with insurance companies. The quality of care and access is still excellent because of their lower patient numbers, like direct primary care doctors.
Private practice doctors also deal with the roadblocks placed by insurance companies, but they are in control of their own scheduling and patient access.
3) Schedule a meet and greet and ask questions.
Call the prospective doctor's office and request a meet and greet visit. I know in my practice, since I will have a limited number of patients, I want those patients to be a great fit.
At the meet and greet, ask about the things that are important to you. Maybe it's access to house calls, or phone visits. Do the hours of the practice work for you? Is a solo doctor you will see each visit, or are there multiple doctors and staff you will be seeing? Is there a focus on preventative medicine? Do you want someone with experience with geriatrics, or someone that can see the whole family in one practice?
4) Most importantly, get a sense of the vibe.
Consider what bothered you about the last doctor you saw. Was there a connection? Did you feel rushed? Your primary care doctor should be someone you feel comfortable sharing all kinds of potentially embarrassing details with. If you don't feel comfortable doing that, you need a new doctor. (I've had patients that were uncomfortable with having a woman perform a particular physical exam - I advised them to find a PCP they are more comfortable with...no judgement!)
I hope I've convinced you of the importance of having a PCP you can trust. I'm passionate about making healthcare better, and I truly believe the base of any good healthcare system is its primary care. Find yourself and your family a great primary care doctor who will be there for you in health and in times of illness - you won't regret investing the time to find that relationship!
Questions? Feel free to email me at firstname.lastname@example.org. I love talking about healthcare!