tient Lack Of Time And Reimbursement – Is That Why Physicians Don’t Do a Better Job Communicating With Patients?

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“I don’t have the time to talk to patients…I don’t get reimbursed for that.”  This is an all too common refrain from primary care physicians and practice managers when ever the subject of improving physician-patient communications comes up.

Money and TimeI get it.   Primary care physicians in particular are under tremendous pressure to produce.   Just imagine…physicians in small primary care practices spend about 3.5 hours/week just on dealing with insurance-related paperwork.  Then there’s keeping up with recommended treatment guidelines, journals, and IT issues and routine staffing issues…not to mention routine patient care, much of which they in fact don not get paid for.  Physicians do have it rough right now.

But Doctors Can Sometimes Be Their Own Worst Enemies

Currently, in just about every State, there are health-plan sponsored pay-for-performance (P4P) and medical home initiatives that reimburse primary care physicians 20% to 30% more for engaging in activities (often of the physicians choosing) aimed at improving quality and patient outcomes.   Some of these initiatives provide additional reimbursement for meeting certain prevention and treatment targets, like making sure that X% of type 2 diabetics have their A1C checked X times a year and the so on.  The evidence shows that small steps like these can collectively have big payoffs in terms of improved quality and outcomes.

Take patient education and chronic care.  Up to 90% of care management for diabetes is provided by the patient and their family.  The quality of self-care among diabetics is a key determinant of patient outcomes.  Patients that engage in high quality self-care have fewer ER visits, fewer re-hospitalizations, have lower risk of complications and a better quality of life.  There is probably evidence out there somewhere which shows that better self-care results in fewer office visits as well.  Yet studies show that primary care physicians spend less than 60 seconds per visit engaging in any form of patient education, including self-care management often because they “don’t have the time.”

Think about it for a second.  Physicians can (and do) actually make more money and freeing up more time in their practice (be more productive) by doing the very things they “don’t have the time” and “are not paid to do.”

The “lack of time and poor reimbursement” mantra hopefully will soon run its course if for no other reason than increasingly it is no longer as accurate as it once was.   But there is another important reason it should go away.  When patients read in blogs like this and KevinMD, that doctors appear to be withholding care for lack of time or money,  they begin to lose trust in the doctors.  They legitimately wonder what needed health services their doctor is withholding from them.  What is my doctor not doing for me that he/she is not telling me?  If you doubt me, just check out the non-physician,  e.g. patient, comments.

And when patients no longer trust their doctors where will that leave us?

That’s what I think.  What’s your opinion?

Source:

Heisler, M. “Actively Engaging Patients in Treatment Decision Making and Monitoring as a Strategy to Improve Hypertension Outcomes in Diabetes Mellitus.” Circulation. 2008:117; 1355–1357.

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Poor Physician-Patient Communication – Is “Lack of Time” Really the Problem?

7 Comments

  1. This is a great topic, and one that has SO MUCH to do with patient satisfaction, and ultimately, with clinical outcomes- for better or worse. What baffles me is that physicians- who should be quite comfortable with basic psychology- continue to disregard the power of human perception. Study after study shows that sincere, high quality doctor-patient communication actually takes MUCH less time than the usual start-stop-I’m-smarter-than-you’ll-ever-be-you’re-just-the-patient conversations physicians insist on practicing. It’s really a shame. A good 5-minute dialogue can oftentimes eliminate the numerous phone calls and unanswered questions that a bad 20-minute consultation can’t. IMHO!

  2. There is considerable healing power in the physician-patient alliance. A patient who entrusts himself to a physician’s care creates ethical obligations that are definite and weighty. Working together, the potential exists to pursue interventions that can significantly improve the patient’s quality of life and health status.

  3. Janet Bruce says:

    I think that many of those same programs meant to increase quality take so much time that they put the doctor under even greater stress with less time to do his or her job. And I create these programs and run them! But I see what it does to physicians. They have no time for a work/life balance. So while I agree with the P4P premises and wish to see better communication people really do need to remember that physicians are only human and would like to be treated as such, just as much as patients.

    • Janet…Thanks for your thoughts! I agree with you up to a point. Physicians make serious, sometime life/death decisions about patients. Unfortunately once they hang up their shingle so to speak, we all have higher expectations of our physicians, including an obligation to communicate in a way that patients can understand and relate to.

      Steve Wilkins

  4. Lola Taylor says:

    I am in complete agreement with you! Doctors really need to start taking a few more moments to establish a clear communication and bond with their patients. Sometimes at the doctor’s office you can feel like just another ten minute time slot in their schedule. It would actually benefit the doctor more if he left a good impression with his/her patients. That one impression can spread the word about that particular doctor therefore bring in more patients/business for that doctor. This post and blog is very in touch with the public’s needs and concerns.

  5. Rebecca Coelius says:

    I would add to the barriers the issue of patient access. By that I mean the shortage of primary care docs in this country has led to large “shadow panels” at most clinics, made up of new patients waiting months for a first appointment. If any of you have ever tried finding a new PCP, you know what I mean. Though the new reimbursement structures help, we are also constantly under pressure (both from gov and our own morality) to help these people access care, which means squeezing them into an already insanely tight schedule. Additionally, surveys show primary care providers to be an extremely stressed and burnt out group due to their practice conditions. This alone can destroy a persons empathy and patience despite their best intensions.

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