Health & Fitness

The doctor-patient relationship is evolving

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Until now, doctors have pretty much called the shots in the doctor-patient relationship. But change is on the way. Patients, say ahhhhh — it's about to be all about you.

The new approach is called patient-centered care, and it's a very good thing, according to Dr. James Rickert, the founder and president of the Society for Patient Centered Orthopedics in Bedford, Ind. "It will mean better outcomes, more satisfied patients and lower costs," he says.

Here are just a few ways your relationship with your doctor may evolve in the not-too-distant future:

Your doctor won't be the boss of you.

"Physicians are experts on likely outcomes, likely effects and side effects," says Dr. Elliott Fisher, a professor of community and family medicine at Dartmouth's Geisel School of Medicine in Hanover, N.H. "But patients are experts on their preferences."

From a doctor's perspective, for instance, replacement surgery might seem like a no-brainer for a patient with a bad knee, Fisher says. But a patient may fear that the procedure will wreck his golf game and choose to delay surgery for as long as possible.

"For most things, there's more than one reasonable choice," says Dr. Michael Barry, a primary-care physician at Massachusetts General Hospital in Boston and president of the Informed Medical Decisions Foundation.

In a patient-centered healthcare universe, doctors will make sure their patients have all the information they need about all their options — and patients will have to tell their doctors their priorities.

"Research suggests that patients want to participate," Barry says, "but they may be afraid to push back, afraid they'll be labeled bad patients. Then it's important for clinicians to draw them out."

You may have a whole team taking care of you.

"There's a lot of inefficiency in the system now," says Dr. Andrew Ellner, co-director of the Harvard Medical School Center for Primary Care in Boston. "Doctors do many things you don't have to be a doctor to do, and that takes time that could be used to develop the doctor-patient relationship."

One answer: teams that include doctors, nurses, pharmacists, nutritionists and social workers.

"The multidisciplinary approach enhances patient care," says Dr. Rina Iofel, a physician at QueensCare Family Clinics in Los Angeles. "Patients get extra time and extra expertise."

When doctors are freed from the duties delegated to other team members, they have more time for establishing relationships with their patients. And patients have the bonus of establishing relationships with the other experts too.

"I make sure patients are taking their medications properly, and we talk about lifestyle issues," says Dr. Ying Wang, a clinical pharmacist who works with Iofel. "I can make a connection with them. It's very rewarding. It's the real reason why I do this."

You and your doctor will spend more time on the Internet.

That's because e-visits will replace some traditional kinds of appointments.

"It's so easy," says Dr. Redonda Miller, an associate professor at the Johns Hopkins University School of Medicine in Baltimore. "Patients love it — 50% of what we do in the office could by done by email."

You may also avail yourself of the extensive medical information that can found on the Web. Your doctor should advise you about reliable sources, says Hedy Wald, a clinical associate professor of family medicine at Brown University. "We don't want people thinking it's a cure to put egg yolks on their heads."

Facilities will be designed with you in mind.

At Stanford University, a new hospital — scheduled to open in 2016 — is being built as a patient-centered facility.

Every one of the 368 rooms will be private, and Internet access will keep patients in constant contact with the outside world. Families will be allowed to visit 24/7, even in intensive-care units. Plus they'll be able to talk with doctors either in person or on a closed-circuit video monitoring system, which can record the discussions and replay them later.

One entire floor — including a huge garden with meandering paths and ocean views — will be reserved for patients and their families. In fact, as much as possible, "the patient experience and the public experience will be separate," says Amir Dan Rubin, chief executive of Stanford Hospital and Clinics.

With your doctor's help, you'll be healthier.

Research shows that patient-centered care leads to better outcomes.

For example, diabetes patients manage their condition better when their doctors show empathy and take time to talk with them about their situation, according to Rickert. "Maybe it's because they have a greater desire to please, or because they understand their treatment better, or they get the extra support they need to stay on track," he says.

There is also evidence that patient-centered care can reduce costs. In a year-long study of 509 adults published in 2011, a patient-centered approach was correlated with fewer visits for specialty care, fewer hospitalizations, fewer lab and diagnostic tests and lower total medical costs.

Doctors want to improve outcomes and lower costs as much as anybody. But they also want to get paid. And under the current fee-for-service payment model, doctors have little financial incentive to practice patient-centered care. Even Rickert, a strong advocate of patient-centered care, says he loses money by practicing it.

"There's a lot of reform coming down the pike," says Dr. Steven Atlas, director of the Primary Care Research and Quality Improvement Network at Massachusetts General Hospital. "As we change doctors' relationship with patients, how we pay doctors will have to change too."

health@latimes.com

Copyright © 2014, Los Angeles Times
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Colleges and UniversitiesStanford UniversityMassachusetts General HospitalHarvard Medical SchoolJohns Hopkins UniversityDiabetesBrown University
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