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Why a deteriorating doctor-patient relationship should worry us

| September 12th, 2017 posted
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Timothy Hoff

Timothy Hoff

In the following post, D’Amore-McKim School of Business Professor Timothy Hoff examines the benefits of strong doctor-patient relationships and what the weakening of those ties means for health care in general.

A version of this post was originally published on the Oxford University Press blog:

If there is a single profound thing that has occurred in health care over the past couple of decades, that has neither benefitted patients or the doctors who care for them, nor the health system as a whole, it is the fairly rapid deterioration of the physician-patient relationship as the centerpiece of effective, satisfying, and high quality health care delivery. Instead of building system improvements around strengthening the relational care between our best trained health care professionals and patients, many health care systems around the world have chosen to place their faith in technologies like electronic medical records, which surveys show makes the doctor’s ability to connect with the patient and spend time with them as an individual more challenging and frustrating. In addition, the industry’s growing corporate takeover of health care delivery, driven by large health systems, insurance plans, and hospitals place the health care organization, not the individual doctor, in front of the patient at every turn. As a result, patients become “consumers”, and the role of the doctor in being the patient’s trusted ally shrinks.

That ongoing doctor-patient relationships built on high levels of trust, empathy, mutual respect, active listening, and expert guidance produce positive benefits is indisputable. These types of relationships are dyadic, interpersonal, and best nurtured through ongoing face-to-face contact between physician and patient. They are organically constructed and maintained, through a commitment by both parties to the relationship that each matters to the other, and behavior on both sides that demonstrate that commitment and the personal accountability that comes with it. If one examines the medical literature over decades, it is clear that these features of strong doctor-patient relationships favorably impact various health outcomes, patient satisfaction, patient compliance and commitment to self-management, and physician satisfaction and burnout.

Doctors benefit immensely from experiencing vibrant relationships with their patients. In survey after survey, physicians state that the most important and satisfying aspect of their jobs is the relationships they can have with their patients, and the intellectual and psychological stimulation that comes from knowing who they are, what they want and need, and perhaps how to get it to them. These same surveys show rising levels of job dissatisfaction, career regret, and burnout—and it should be no secret to assume that these negative outcomes are in part due to doctors experiencing less and less of the relational depth with their patients they so desire. Patients also know the personal value of connecting with a particular physician, and establishing a rapport and level of trust with them over time. We need health care often at the most vulnerable times in our lives, when we are filled with uncertainty and fear. The opportunity for us to share our thoughts and emotions with doctors, to have them hear us out and offer guidance based on who we are as unique human beings, and help us make important decisions about our health depends directly on having someone well-trained and accessible to believe in and trust.

Increasingly, though, the health care delivery system pushes a cheapened version of transactional care at the expense of doing things to strengthen this relational bond between doctor and patient. It commodifies health care services at every turn, creating buying and selling opportunities to push new, often unproven treatments and products onto patients for the sake of profit rather than quality of care; markets the illusory features of “company brand” to gain patient loyalties as if we were in the health care market for automobiles, televisions, or smartphones rather than improved well-being and emotional support; standardizes care delivery in ways that treat all patients as exactly the same in terms of needs and wants; and then seeks to have us believe that things like convenience and ease of access, while important and necessary in their own rights, are really the most important things we want from our health care delivery system.

Read the full post on the Oxford University Press blog.

Timothy Hoff is a professor of Management, Healthcare Systems, and Health Policy at the D’Amore-McKim School of Business and visiting associate fellow at Oxford University. His primary research interests are in the area of health policy and management. He is co-director of the Full-Time MBA Healthcare Management Track, a distinguished two-year program that allows students to combine their passion for healthcare with word-class business knowledge. His new book, published by Oxford University Press, is entitled Next in Line: Lowered Care Expectations in the Age of Retail- and Value-Based Health and is available in print and online.

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