By Francesca Mathewes

The relationship between physicians and their patients has come under intense pressure in recent years as medical misinformation and corporate interests become dominant forces in healthcare.

Three physicians recently convened to discuss what they see as the biggest disruptions to the physician-patient dynamic.

Question: Patient-physician relationships face significant pressures in modern healthcare. What do you see as the No. 1 impediment to the physician-patient dynamic right now? How can this be addressed?

Joe deKay, DO. Family Practice Physician (Hiram, Maine): The patient physician relationship hinges upon the ability to be available in person, by phone and online. A physician’s time has value, and the patient needs to learn availability has costs which the current system faces in limited ways. Practices need to negotiate with patients with ears and eyes open.

Practice and community-based research designed to be practical for clinicians with busy schedules enlivens professionalism, collegiality and sense of purpose. Increasingly, administrators recognized the value added when front-line healthcare comes up with research topics which address frustration and difficulties.

Alexander Levit, MD. Medical Director of Hospital at Home at Lee Health System (Fort Myers, Fla.): Physician-patient relationships are undermined by many factors, the most important of which include face-to-face time constraints and impediments to patients being able to make truly informed decisions. The former is, finally, being addressed rather well with AI scribes and impending regulations against prior authorizations. The latter requires more daunting reforms.

As it stands, payers, regulations and administrative burdens — often including high turnover — all work to add barriers to the patient’s ability to see all the costs associated with a decision. The physicians in our modern system are trained well in presenting patients and families with options of aggressive or conservative treatment plans with their respective ranges of morbidity expectations. However, patients come to the physician with impossible-to-foresee decisions that have already been made by payors on their behalf. These decisions are often far more costly — in time and price — than what would have been suggested by the level of consensus reached in the medical community. A singular example here would be warfarin versus [direct oral anticoagulants]. More complex “pre-made” decisions include the cost and quality of skilled nursing care made available to elderly patients on [Medicare Advantage] plans. Patients on low quality MA plans often face unexpectedly poor choices in both [skilled nursing facility] and [durable medical equipment] providers with unexpected out-of-pocket burdens. Foreknowledge on the part of the physician may very well change his or her treatment recommendations. The recently unveiled “Great Healthcare Plan” addresses some of these issues rhetorically — e.g. in requiring payers to make clear and plain language on what is covered — but time will tell if such requirements are enforced or efficacious.

Rhett McLaren, MD. Premier Pediatric Consultants (San Antonio): As I see it, the primary impediment to the physician-patient dynamic is communication.

Traditionally, patients relied primarily on word of mouth and periodicals for medical information. Thus, when patients came to the physician for care they did not have strong preconceptions about what the diagnosis was or what care was needed. They chose doctors they trusted and relied on them to provide the correct answers and treatment plans for their problems. This trust was further enhanced by the doctor appearing unrushed and having the time to demonstrate care and concern for the patient. In addition, negative information about doctors or the healthcare system was sparse, so there was no inherent reason not to trust the healthcare system.

During the past decade, the number of different sources that patients receive medical and health information from has grown exponentially. There is social media, vendors pushing alternative treatments, direct access to medical information sources, marketing by healthcare entities and an infinite number of “news sources.” This explosion in alternative health information has gone largely unchecked by evidence-based information authorities. Now, when patients present to doctors for care they have strong, often inaccurate opinions about what the diagnosis is and what treatments are needed. This is then combined with doctors who are rushed and directed by entities other than scientific or medical and then appear uncaring, objectionable, or uninterested. Poor perception of physicians is further compounded by widely circulated accounts of poor clinical outcomes or the rare badly behaving physicians.

We thus need to meet patients where they are at. We need to be present in the virtual world and offer balanced and unbiased answers to the problems patients are seeking help for. We need to be provided with and utilize the increased time it takes to address patient concerns and need for explanation and education. Only then, through communication, will we be able to rebuild trust and our position as experts in the medical care of people.