Imagine you’re sitting in the exam room. The nurse has already gone over your history, noted your symptoms, and taken your vitals. As you start to read the informational poster on the wall for the fifteenth time, you hear a knock on the door. The doctor dashes into the room with her nose in your chart. For a whirlwind 5-10 minutes, she does her best to focus on your concerns. But you can tell her mind is already out the door as she shouts orders to her assistant, shakes your hand, and runs off to her next waiting patient. Sound familiar? You’re not alone.
Today’s high-tech hospitals are a far cry from the early 1900s when provincial care providers made house calls with their leather instrument bags. But with all of this progress, we’ve lost something vital. Between changes to record-keeping systems, the physician shortage, and growing urban populations, it’s no surprise that the relationship between doctors and their patients has changed. But is it evolving or crumbling?
Understanding the doctor-patient relationship
Think about your current primary care physician. What keeps you coming back to their office? If you’re like most patients, you want a doctor who communicates well, seems organized and conscientious, and makes you feel genuinely cared for. In fact, according to a review of patient satisfaction surveys, most people value empathy and listening skills as highly as doctors’ medical skills. At its core, medicine is a social process. Patients put their health in their doctor’s hands—an act that requires a high degree of mutual trust, respect, and cooperation.
Why is the doctor-patient relationship so important?
William Osler, who is widely regarded as the father of modern medicine, said it best. “The good physician treats the disease. The great physician treats the patient who has the disease.” A healthy doctor-patient relationship allows the physician to understand and relate to the patient as a whole person, not just a list of symptoms. Plus when patients trust their doctors, they’re more willing to share sensitive information that might impact the diagnosis and treatment.
Types of doctor-patient relationships
Over the years, studies have focused on the history of the doctor-patient relationship. Their goal is to improve treatment outcomes by understanding how doctors and patients interact with one another. Researchers have identified three primary models that are either physician-focused or patient-focused and may vary from doctor to doctor, or even from doctor to patient.
This model, which many find imbalanced, creates a dynamic of all-knowing physicians treating helpless patients. The passive patient is expected to comply with all of the doctor’s recommendations. Most modern medicine has shifted away from this model, as patients take a more active role in their health and wellness.
Though less imbalanced than the activity-passivity model, guidance-cooperation still centers on the doctor’s authority. They have knowledge that the patient lacks and are expected to guide the patient towards the appropriate treatment plan. Once again, the patient does not play an active role in their own treatment.
Mutual participation model
Widely regarded as the most progressive model for a doctor-patient relationship, mutual participation acknowledges that both the doctor and the patient as experts. The doctor has years of medical training and knowledge. The patient is an expert when it comes to their symptoms and experiences with illness. They work together as a team to create a treatment plan, which boosts patient compliance.
Dr. Aaron George, a Doctor of Osteopathic Medicine, echoes this sentiment in an article for Medical Economics. “I regularly encourage my patients to explore and understand their own health. I believe the past role of the physician as sole purveyor of knowledge is outmoded. Patients hold more information in the palms of their hands than I could ever hope to encapsulate in years of study.”
This type of patient-centered medicine relies on a healthy doctor-patient relationship. Both the doctor and the patient need to feel comfortable sharing and discussing personal and private matters. In a safe and constructive environment, patients should feel seen and supported, not rushed or patronized. So what gets in the way of the doctor-patient relationship? And how is telehealth working to restore it?
Doctor shortages and burnout
The majority of doctors say they would like to support their patients through mutual participation. Unfortunately, there just isn’t enough time in the day to build that connection with each of them. Where’s the disconnect between best practice and medical practice? One study found that the average US primary care physician manages 2,300 patients and sees about 94 of them each week. Similarly, doctors in the UK are being asked to cap their daily caseload at 25 appointments per day. That’s a drastic cut from the 41.5 face-to-face appointments and 30 or more telephone appointments most actually manage.
Now take those heavy caseloads and add the burden of charting and paperwork. According to a 2017 Forbes report, doctors spend half their time with patients and the other half finishing administrative tasks—charting, refilling prescriptions, responding to messages. For many doctors, the workday doesn’t end just because the practice closes for the night. As Peter Ubel writes, “Their kids go to bed, and they go back to their computers, to document all their clinical activities.”
When you add Canada’s physician shortage to the list of symptoms, it’s no wonder the doctor-patient relationship is sick. Despite many family doctors across the provinces being retirement age, enrollment in medical school has remained flat. That means as doctors retire, there’s nobody to replace them. The result? According to The Telegram, approximately 175,000 people across Atlantic Canada do not have a family doctor.
How telehealth can help restore the doctor-patient relationship
Imagine if each of those 175,000 people on the waitlist could reach a doctor instantly, from the comfort of their own homes. Today, many physicians see telehealth as the answer to closing the rift between doctors and their patients. Virtual appointments help build trust, improve accessibility, and maintain continuity of care when it comes to treating chronic conditions.
Dr. Glen McCracken is a physician with the University of Arizona Telemedicine Program. He writes, “As a physician with over 20 years of practicing medicine, I’ve always been an advocate of strong doctor-patient relationships. The strength of that relationship is the core of high-quality patient care. Contrary to what some physicians think, I believe telemedicine actually has the power to enhance and harness that relationship — if we use it in the right way.”
Through virtual health platforms, doctors can do the same visual assessments they’d use in the exam room. They can easily check breathing, skin tone, mobility, cognition, and speech clarity. However, that’s just the start of what we can accomplish through telehealth. As doctors become more comfortable using the online system, they can address health problems quickly and efficiently, leading to greater patient satisfaction.
Telehealth also benefits doctors directly
Countries that have widely implemented telehealth services, such as the United States, have also seen how it helps doctors. In 2014, approximately 135,000 Americans used telemedicine services. By 2015, that number exploded to 15 million. Telehealth visits cost less and require fewer resources. Plus, because it is so convenient, more patients use telemedicine to address healthcare issues before they become emergencies. That takes the strain off of urgent and emergency care doctors, leaving more time and mental capacity for actual life-threatening emergencies.
This technology also gives physicians more freedom, empowering them to improve work-life balance by increasing their income without sacrificing their personal time. Less burnout means more time and attention to invest in the doctor-patient relationship.
Telehealth will continue to shape the doctor-patient relationship
As technology continues to disrupt the healthcare industry, we know one thing for sure: virtual health platforms like Lumeca will continue to shape the doctor-patient relationship. In fact, many believe that telemedicine could be the solution to poor accessibility, long wait times, and doctors suffering from burnout.