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Home Health The doctor-patient relationship – dissolution or evolution
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The doctor-patient relationship – dissolution or evolution
Written by Ken Chisholm, RN; BS; CNOR; CRNFA; OPA   
Monday, 08 April 2013 09:47

I can remember way back in the dim distant past, when I was very young, I had episodes of illness like all of us did.

Whenever the “croup” befell one of the kids, or when I or one of my siblings was down-and-out at home with a high fever, the trusted family doctor would visit the house, give a shot or prescribe some medication. Furthermore, I remember a time when I would go to the doctor and actually see the doctor – for longer than five or 10 minutes. Now, I can just hear people saying this article is going to be a dig against the doctors, or a “whine-and-cheese” session. Au contraire…

While certainly not a lost art, the ever-evolving environment of medicine and healthcare has led us to a point in history where, in many instances, to personally see your physician is not quite always a “given” when you go for an appointment. That said, the advent of “mid-level” providers (translate “physician assistants,” “nurse practitioners”) and technology-driven alternatives (a.k.a. “tele-medicine”) has opened up new avenues for patients to receive care, and for physicians to effectively “extend” their practices.

Is this good, bad or indifferent? Well, let’s look at it from a couple angles and you make the call.

Many people argue that the current state of healthcare has led to patients/consumers “acquiescing” or surrendering their “right” to see the doctor in favor of a non-physician professional and somehow feel slighted if not seen personally by the physician.

Still, others who feel that clinical judgment must be imparted in a true face-to-face scenario strongly resist the ever-increasing use of technology, and adjunct professionals in the diagnosing and management of patients’ conditions in a “remote” setting.

“Why?’ you ask, “has health care gotten to this state of affairs where a person has to fight just to see their doctor?”

Well, having been one of those “mid-levelers” for literally my entire career, I can tell you that I was very good at what I did and I had the trust of my sponsoring physicians as well as the patients I saw. I also knew that, whenever a patient voiced a desire to see the doctor directly, I made that happen.

There is absolutely nothing wrong with that desire but where the confusion and subsequently, the frustration and anger, come in is that these desires are rarely made known until the actual appointment. Then, it can be somewhat tricky at times to juggle patient load which was initially scheduled according to some being seen by the nurse practitioner or physician assistant.

It goes without saying that mid-level providers are typically very well-trained and very good at what they do as well. I say typically because, let’s face it, like medicine itself, there are variations in skill, training and knowledge levels. Many times, patients will prefer to see the non-physician provider for more routine situations because they tend to be more “schedule-friendly” and offer an equivalent level of expertise and care. How autonomous and independent a non-physician provider can be varies widely from state to state, so it would pay for you to bone up on what is the norm in your particular area.

Health systems and insurance providers are placing more and more burdens on physicians/surgeons to see more patients in less time, robbing them of the ability to spend quality time to foster the relationships we hold so dear. Decreasing reimbursements for services rendered forces practitioners to jam more patients into their office hours to make up for the “hit, resulting in the “assembly-line” feeling none of us want. Most physicians have little alternative but to enhance his/her work force to even be able to accommodate the patient loads and insurance provider demands.

Enough about the professionals in healthcare.

Personally, I think the increased presence and utilization of technology has done more to widen the doctor-patient relationship gap that anything. While we bask in the awe and wonder of space-age technology allowing patients to be evaluated, and even treated, thousands of miles away from their provider, we see that the old-fashioned healthcare that we knew and loved, slowly vanishing. In this day and age, patients are even “seeing” their doctor by way of Skype or some other more privacy-protected, audio/visual get-up.

Ever try showing your “boo-boo” to an iPad?

For those of you who are steadfast in your desire to personally see your physician, take heart; you still can. Just remember to have that conversation at the time you are making the appointment, rather in the examination room when it’s most likely too late.  You may have to settle for a less-than-optimal appointment time or wait an extra week or two, but you’ll get your wish.

Here’s the take-away: healthcare, like medicine, is advancing and a tremendous pace. How it looks today will most likely not resemble what it will look like in 20 years, much the same as how medicine and healthcare looked 30 to 40 years ago when the doctor wore that funny reflector on his forehead to bounce light into your throat.

Like so many other things in life, change is inevitable. We can spend time complaining about it and reminisce about the “good old days” or find ways to embrace these wonderful and often unbelievable advancements in how disease can be treated. The key is to understand and “own” your individual desires and expectations. You can then work with the healthcare system to get the care you need, and like Burger King: “get it your way”.

I don’t believe the doctor-patient relationship is disappearing. Rather it is simply evolving.

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By: Ken Chisholm, RN; BS; CNOR; CRNFA; OPA

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