Mend The Broken Doctor-Patient Relationship

I've spoken to many working-class citizens who are convinced that hospitals and doctors are interested only in making a buck, that most of the medical tests they run are unnecessary, that they perform most surgeries just to line their pockets, and that they make drug prescribing decisions to get kickbacks from a pharmaceutical company.

What has happened to that once sacred physician-patient relationship? Although this isn't the place to discuss all the cultural, political, and economic contributors, suffice it to say both parties share the blame. The more important question: How can we fix this situation? And what role can IT play?

The less cynical public has for decades bestowed upon the medical profession the same reverence it once reserved for religious leaders. It's time to give up that adolescent attitude and realize that, despite their deep knowledge of the human body, physicians are fallible.

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Technology has made that fact abundantly clear. Patients can, for instance, find a physician's malpractice record and any disciplinary actions by going to the website for a state's medical licensing board. And we now know how much money US doctors accept as consultants to drug and medical device companies -- about $380 million from August to December 2013, according to federal data reported in a recent New York Times article.

Add to that information the growing number of published reports about wasteful spending in the healthcare industry, and it's easy to understand the gulf between providers and patients. In a recent Procedia Computer Science report, for instance, Saudi Arabian researchers who extracted information from a data warehouse of a tertiary care hospital found that "more than 11% of ordered tests are repeated, over-utilized, and simply unnecessary and could be eliminated."

Three tests -- complete blood count, renal profile, and blood glucose -- constituted 35% of all the hospital's inpatient lab tests, according to the report, which found that 10% of ordering physicians were responsible for overusing the lab testing.

Fortunately, technology can also help curb this wastefulness. As the US Department of Health and Human Services points out on its healthcare IT website: "Because EHRs contain all of a patient's health information in one place, it is less likely that providers will have to spend time ordering… unnecessary or duplicate tests and medical procedures. Less utilization means fewer costs." In addition, patients can have more informed discussions with their doctors by researching their illnesses or diseases on reputable sites.

Physicians need to get real
Clinicians have played into the public's worshipful mindset. Sometimes you hear it in the tone of their voice, in their overconfidence in a particular treatment they're recommending, or in their unwillingness to admit their mistakes after a mishap.

But that attitude is slowly changing, especially among younger physicians. Technology can speed up this transformation, helping to mend the doctor-patient relationship by changing both the public's misconceptions and the profession's elevated self-image.

Patient engagement software is a good place to start. The federal government now expects any provider that has taken government financial incentives to install an EHR system to prove that it's engaging patients in a meaningful way. But the bare-bones requirements spelled out in the Meaningful Use regulations don't come close to what's needed to close the widening gap between providers and patients.

Genuine patient engagement requires clinicians to adapt a customer-relations mindset and to be transparent about the costs of procedures and services. If you wouldn't take your car in for a transmission repair without getting an estimate, why should you be expected to submit to a surgical procedure without some explanation about the price tag?

True patient engagement also requires clinicians to replace paternalistic relationships with doctor-patient partnerships, both online and in person. Of course, patients must know when they're stepping over the line. You can't, for instance, expect 24/7 email access to your doctor. And it's unlikely he or she is going to friend you on Facebook.

Similarly, if your doctor orders a battery of tests that seem to make no sense and reveal that you're totally fine, don't automatically assume the doctor is wasting your money or getting a kickback. Sometimes the only way to determine if your lingering cough is caused by a life-threatening disease or a minor, self-limiting infection is to run expensive tests. Negative results don't mean your doctor wasted your money. Most often, they just mean you can sleep easy.

The owners of electronic health records aren't necessarily the patients. How much control should they have? Get the new Who Owns Patient Data? issue of InformationWeek Healthcare today.