I had never cried in a doctor's office. But there I was, a few weeks back, sobbing in the exam room.
As a new resident of Fort Myers, Florida, I was trying to establish a relationship with a local primary care physician. From the start, the doctor's focus was her computer, not me. She stared at a screen, while I stared off into space.
She challenged me on why I had an inhaler prescribed by a previous doctor. I explained that hay fever leaves me short of breath. But her screen said I needed an asthma diagnosis, which I don't have. Then she asked why my blood pressure was so high – a first for me. Bewildered, I said I had ended a lifelong friendship the night before. Sidetracked again: It turns out there is no software code for that. I needed a dose of kindness and some clinical insight. I got clicking and keystrokes instead.
The tears flowed soon after. All I wanted was a human connection, but the doctor-patient relationship – the most important element in all of health care – was dead on arrival.
To be clear, the doctor is a victim as much as I am. In 20-plus years as a patient advocate and policy wonk, I’ve seen how electronic records chain doctors to keyboards, how independent primary care doctors are disappearing, and how financial incentives in government billing leave doctors with less time to spend with patients. There’s plenty of focus on each of these issues, and many others. Yet there’s not nearly enough emphasis on the larger crisis they’ve created. The doctor-patient relationship is collapsing.
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The breakdown of relationships is bringing health care to the breaking point. In conversations with hundreds of health professionals, I’ve heard that it’s all but impossible to develop the kind of genuine relationships that facilitate better health for patients and higher professional satisfaction for doctors. No wonder half of doctors and nurses are burned out. No wonder they are leaving health care in droves. And no wonder about half of Americans say health care is getting worse.
Human and financial costs
The pandemic didn’t help at all, thanks to virtual visits, masks that hide smiles and the politicization of medical treatment that introduced distrust into the doctor-patient relationship.
The lack of connection like I experienced is costly in both human and financial terms. Studies show a strong doctor-patient relationship improves patient health outcomes. Evidence also shows that a continuous bond between a patient and primary doctor reduces costs. Without it, patients will go anywhere for care, regardless of quality or cost. They go to pharmacies, urgent care and emergency rooms, instead of coordinating with a single physician.
The result is as well documented as it is painful: higher costs and poorer health.
Long-term reforms depend on policymakers and health professionals, but in the short run, there are important steps that each of us can take.
To start, patients can connect with their health providers on a more personal level. After all, the doctor-patient relationship is a two-way street. Remember when we all banged pots and pans in the pandemic to honor our health care heroes? We should do something similar, if quieter. Honestly, I could have done a better job at my recent appointment. A couple of personal questions would have gone a long way.
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Doctors can rethink their workflow and leverage team members to reduce the time spent on documentation. That will free up time to develop more meaningful relationships with patients. While the system too often stands in the way, it’s time we fight back, one conversation at a time.
Time for relationship building
Patients and doctors can also come together to ask hospital or doctor’s office administrators to ease off the relentless push for efficiency and create more time for relationship building. I've seen a united front achieve success many times, including recently at health systems in Rochester, New York, and Jackson, Mississippi. Heartfelt conversations led to less physician burnout and better patient experiences, while inspiring hospital administrators to prioritize the bonds at the heart of health care.
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Health care needs an infusion of relationships, for the benefit of everyone in health care and society as a whole. I’m not the only one who has had a horrible experience at the doctor’s office, and the doctor I saw isn’t the only one who’s unhappy. We’re drifting apart, but if we work together, we can start to heal our increasingly sick health care system.
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