Doctor-Patient Relationship Archives | Bill of Health
Discrimination in the Doctor-Patient Relationship make the obligatory pitch for my book, Conflicts of Conscience in Health Care, which is now. The physician-patient relationship is a bedrock of the U.S. health system. (Most practices permit online bill payment and little more). All want their clinicians to disclose their conflicts of interest i.e. business relationships. Similarly, if you call your doctor's office off-hours, the covering doctor, whom may have no prior relationship with you, may similarly access these.
Sometimes these refusals can be clearly categorized as conscientious objections religious or otherwise. But for the patient, all of these refusals can feel discriminatory. And that raises the obvious question: Sometimes yes, and sometimes no. First, bear with me while I make the obligatory pitch for my book, Conflicts of Conscience in Health Carewhich is now a few years old, but the issues are still very much live.
In that book, I delve deeply into the question of how to balance provider conscience and patient access.
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In general, I argue that it is important to protect provider conscience, to a point or points — and those points have to do with burden on the patient and avoidance of invidious discrimination. Simplifying a great deal, the gist is that consistent refusals to provide a particular objectionable service to any patient ought be accepted, unless they cause unacceptable patient access problems. On the other hand, refusals to provide a service only to certain types of patients one finds objectionable ought not be accepted, regardless of whether they cause any patient access problems whatsoever.
Notice that I specify moral grounds to distinguish refusals based on things like scientific or medical judgment, expertise, etc.
Refusing an obese patient because they would be better treated by someone else is a different story. And physicians routinely compare notes among themselves about problem patients with whom interactions are routinely difficult.
Through the years, the American Medical Association and every major medical organization have opined consistently to the need for strong physician-patient relationships.From Friends to 'Friending': The Impact of Social Networking on Physician-Patient Boundaries
Physicians understand their importance: They understand that a pleasant bedside manner is not necessarily correlated to clinical competency and skillfulness but both are important. And they recognize that changes in their environment are driving a wedge between how they practice and the expectations patients have for the relationship.
More physicians are now practicing in larger groups, and one third are employed in hospitals MGMA. That means the clinical judgement of a clinician often is part of a larger scheme for managing patients consistently to optimize clinical coordination and efficiently to maximize productivity and revenues.
Peer reviews, utilization management and comparative effectiveness are now part of their lexicon.
Discrimination in the Doctor-Patient Relationship
The democratization of medical knowledge via social media and readily accessible clinical guidelines from reputable sources means patients have more questions and are often armed with inaccurate or harmful information.
Physician income pressures are mounting. Granted, their incomes remain healthy compared to the overall population ranging from 3: And they react viscerally to the notion that physician greed is systemic. And physicians understand that ratings by patients are here to stay. Patients expect to be able to compare the quality of medical care they receive just as they compare every other high-profile profession.
And physicians know their ratings matter to payers like Medicare who penalize them for poor patient experience ratings.
Discrimination in the Doctor-Patient Relationship | Bill of Health
Against this backdrop, most physicians believe their relationships with patients are less than ideal due to circumstances beyond their control. The majority think the profession is being compromised by external intrusions that limit their effectiveness as clinicians and compromise their relationships with patients.
They want to spend more time with patients but recognize the gap between their wishes and reality is widening.
Patients see a gap, but their perspective is different. They see their physicians in positions of power and trust who are highly compensated and knowledgeable.
They do not understand the complexities of modern medical practice nor do they believe them insurmountable.
Their wish list is simple: Most want to learn more about their condition from sources that are evidence-based and independent. Most believe they should have complete access to their own medical record without cost or hassle.
Most think their physicians should leverage online technologies to allow online scheduling, tele-visits, secure messaging and more.