A Unique Way to Salvage the Doctor-Patient Relationship

Posted on October 31, 2007
Filed Under General Rationing Issues, Primary Care in America |

As we have seen, covert healthcare rationing requires destruction of the classic doctor-patient relationship (since a common final pathway for covert rationing is the bedside). The government and private insurers accomplish this task by several mechanisms, but the one that has recently gotten the most attention on this blog is the gambit of severely limiting the time doctors can spend with a patient during each visit (through overt “efficiency” mandates, or through slightly less subtle economic disincentives), then scripting what the doctor must talk about during that limited time (through P4P).

In her “The Informed Patient” column in today’s Wall Street Journal, Laura Landro talks about efforts being made by some patients and some doctors to try to remedy this dire situation.

Savvy patients, recognizing that their lives may depend on getting their doctors to address their important medical issues (instead of the ones on an imposed checklist), and recognizing they only have a few minutes of face time to accomplish this goal, are turning to experts for help. And certain physicians and organizations are stepping up to the plate to help.

Landro points us to Dr. Marisa Weiss, a radiation oncologist who delivers a very clever presentation (from the standpoint of the patient) on how to talk to your doctor, and who has written a book on the same topic called (tellingly) “Seven Minutes: How to Get the Most from Your Doctor Visit.” This is the most approprate title DrRich can imagine for a book on the modern doctor-patient relationship.

Landro also mentions efforts like the Shared Decision-Making program pioneered by the Dartmouth-Hitchcock Medical Center in Lebanon, N.H., which has created a library of materials that patients can use to bring themselves up to speed on their medical conditions, so they can approach their brief audiences with their doctors armed with a reasonable foundation of knowledge.

Finally, Landro points us to Dr. Delia Chiaramonte, who established Insight Medical Consultants, a company whose mission is to help patients navigate the hostile American healthcare system. Delia (who wrote the compelling Afterword for DrRich’s book), is a true American medical pioneer. A well-trained and dedicated practicing internist, Delia eventually became terminally frustrated by the rules, performance guidelines, time limitations, and all the other ploys externally imposed on American doctors today to prevent them from fulfilling their duties under the classic doctor-patient relationship. She could have done what many other doctors do in similar circumstances - become a pathologist (a specialty where the doctor-patient relationship remains blissfully unhurried), become a florist or deep-sea fisherperson, or simply resign herself to an unfulfilling and frustrating career.

She chose instead to invent a brand new kind of medical career. If you’re not allowed to have a doctor-patient relationship within the practice of medicine, she reasoned, then maybe you can have one outside the practice of medicine - as a professional patient consultant. Delia offers private medical consultation to patients who need help that their own doctors are unable to give them. Her services include offering patients in-depth education on their illnesses, helping them research their options for therapy, assisting them with insurance issues, coaching them on getting the most out of doctor visits, and even accompanying them to important doctor visits. She offers patients what they really need, and what she wanted to offer them as an internist but wasn’t able to. By making patients more knowledgeable and more confident, Delia aims to strengthen their relationships with their own doctors - at least those doctors who believe in shared decision making and not in paternalistic medicine - rather than undermine it.

The path Delia has chosen toward her own medical fulfillment uniquely fills a vacuum in American healthcare that is (systematically) becoming more pronounced by the day, but that is only now being recognized by substantial numbers of doctors and patients. Her model is one that utterly discouraged American physicians might want to consider as they weigh their options. And it is certainly one that purposely-abandoned American patients should seek out, for their self-preservation.

Comments

4 Responses to “A Unique Way to Salvage the Doctor-Patient Relationship”

  1. drmatt on November 1st, 2007 6:17 am

    GO DELIA, how do I get one started? I too have sadly left the practice of clinical medicine.

  2. Healthcare Economist · Doctor, Doctor, Lend me Your Ear on November 6th, 2007 1:37 am

    [...] on building a good doctor-patient relationship from the patient side. Thanks to Dr. Rich’s Covert Rationing blog for the [...]

  3. DrRich on November 6th, 2007 9:07 am

    drmatt,

    You can contact Delia through her website (link given above). She’d probably be happy to give you advice if you’re thinking about doing the same thing.

  4. L-E on May 23rd, 2008 9:45 am

    I’m very grateful for all of the information in your blog, and in particular this information about Dr. Chiaramonte. I have a condition for which one reasonable approach is “watchful waiting.” However, I’m coming to believe that I should carefully review all of the more aggressive options now. I’m worried about what the health insurance context might be if I continue with this strategy but end up needing a more aggressive option in the future.

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