Can doctors and patients heal their injured relationship?
The grievances cut both ways: Patients say doctors don't answer calls in an emergency, keep them waiting endlessly during office visits, and don't take the time to explain things properly.
Doctors counter that patients don't comply with their treatment regimens, ignore professional advice in favor of sketchy information found online, and don't come clean about their complete health histories.
Those pet peeves emerged between doctors and patients at a summit of about 200 representatives from both sides, convened recently by Johns Hopkins University and disease-management company American Healthways.
Their resulting report, "Defining the Patient-Physician Relationship for the 21st Century," calls for some sweeping changes in the way doctors practice medicine, from eliminating long waiting times and rude staffers in doctors' offices to offering more "collaborative" discussions and personalized care.
The full set of recommendations, which will be sent to about 10,000 government representatives, health plans and doctors around the country, is available online on a new Web site, www.patient-physician.com.
Though many of its ideas aren't new, the doctor-patient summit did seek more input than usual from patients and consumers on issues that have mainly been studied in academic and health-policy circles until now.
The report acknowledges the changes that have roiled the traditional doctor-patient relationship. Long gone are the days of TV's Marcus Welby, the ideal of "a knowledgeable, beneficent and genuinely caring physician guiding the treatment of respecting, trustful and grateful patients," the Hopkins-Healthways report notes. Patients "are no longer recipients of care or subjects of research, but active informed individuals who know more about their condition and exert more control over their own care."
At the same time, evolving medical technology and treatment, new government regulations and cuts in reimbursement have put pressures and demands on physicians that never existed in the fictional Dr. Welby's day.
While advocates of change have been calling for a more "patient-centered" approach to care for years, the idea of treating patients more like equals in medical decision-making and transforming the traditional relationship is only now starting to make its way into practice. The medical education system is increasingly emphasizing communication skills such as how to convey sensitive or traumatic information. Researchers are studying doctor-patient encounters to measure and score how well doctors measure up on things like "empathy" levels. The American Academy on Physician and Patient (www.physicianpatient.org) is sponsoring a weeklong course in June for medical faculty on how to teach doctor-patient communication skills for children, families, and adults of different ages.
From a practical standpoint, American Healthways hopes to use the report to help develop treatment guidelines for the thousands of doctors it works with in its primary business: monitoring more than one million chronically ill patients for health plans and employers.
To ensure better quality care, patients and doctors first need to reconcile the expectations of their "contract" with each other, says James Pope, American Healthways' chief medical officer. Consumers contract with car dealers or lawn-care services with a clear understanding of what they will get for their money, "but when it comes to health care, all that goes right out the window," Dr. Pope says. The summit report should also add fuel to the growing debate on how to change the medical payment system to reward doctors for quality care, he adds.
While spelling out a number of steps doctors need to take to improve bedside manner and better collaborate with patients on treatment plans, the report also says patients need to hold up their end of the bargain. That means adhering to their regimens, coming to visits prepared with a list of questions and issues, and sharing medical histories accurately.
"It was novel and at first scary putting doctors and patients around the same table as co-equals in a relationship," says Frederick Brancati, the Johns Hopkins University medical professor who directs its Outcomes Evaluation Program, and one of the designers of the summit. "But patients felt empowered to be frank," he says. Some complained about insensitivity, such as the doctor who prescribed an alcohol-based cough medicine for a recovering alcoholic; others about slipshod treatment such as not responding to repeated calls about a racing heart.
Jeanne Sievers, one of the members of the patient steering committee for the summit, says she became increasingly frustrated with her endocrinologist after she was diagnosed with gestational diabetes during her pregnancy. "He didn't spend any time with me, didn't discuss the long-term effects of the disease, and didn't ask me if I wanted to learn more," says the 42-year-old South Yarmouth, Mass., resident who works as a legal representative.
Ms. Sievers says that while she often complained to others, she never confronted the doctor herself. After the summit, she felt better prepared to do so. "When I faced him and said this is what I want and what I need taken care of, it worked -- and we got a much better relationship."
Patients were also surprised at hearing how hard things can be for doctors.
Mary Grace Reed, a Farmington, Conn., event planner and caregiver for several sick family members, helped craft the recommendation that doctors respect the role of a patient's chosen "advocate," such as a friend or family member. But she says she also came to understand how difficult it could be for doctors when family members "interfere" in a counterproductive way. "We may feel more empowered," says Ms. Reed, "but being in power isn't to be confused with not being respectful."
