Harnessing the Power of the Physician-Patient Relationship

PATIENT SUPPORT IS KEY: DOCTORS CAN'T DO IT ON THEIR OWN.

Written by Dr. Rebekah Bernard, MD

It is no great secret that physicians are increasingly disillusioned with the healthcare system, with nearly half of all physicians actively planning to leave the clinical practice of medicine.

The reason that doctors want out of medicine has absolutely nothing to do with patients. In fact, physicians rank patient care as the most meaningful part of their job and consider patient relationships the greatest source of professional satisfaction.

Likewise, patients value their relationship with physicians. 92% of American patients report being happy with the care they receive from their primary care physicians, and 80% of Americans rate the quality of the healthcare they personally receive as "excellent" or "good."

Indeed, patients benefit from a strong relationship with their physician. Studies show that having the same physician over time is associated with lower rates of mortality.

But while Americans value their personal physician, most are dissatisfied (Jones, J. & Reinhart RJ, 2018) with the health care system in general, particularly the cost of health care.

Doctors are also deeply dismayed with the healthcare system, and report that paperwork, burdensome electronic health systems, and meaningless rules and regulations are driving their exodus out of clinical medicine.

Patients are not oblivious to the toll that the system has placed on physicians. Many express empathy at seeing their personal physician hunched over a computer keyboard, despite their disappointment at a lack of eye contact during the visit. Knowing the burden of documentation requirements on doctors, most patients will accept scribes to be present during their office visit, allowing a third party to hear their most frightening symptoms and deepest worries. And increasingly, patients are paying a premium for more personalized medical care outside of the system, including concierge and direct primary care services.

While study after study confirms these root causes of physician burnout, expert recommendations consistently fail to address systemic changes necessary to relieve the burden on physicians. Instead, doctors are told to manage their time better, delegate more responsibilities to team members like nurses and scribes, and become more resilient to the changes in health care.

With more than 50% of physicians now working as employees of corporations, administrators now call the shots. These doctors have little choice: get “resilient”—or get fired. And even when physicians play by all the rules, they may still lose their jobs, with healthcare organizations increasingly replacing doctors with nurse practitioners and physician assistants as a cost-saving measure. While many patients understand some of the burden being placed on physicians, most do not realize how little power and control the average physician has today. And very few realize how quickly their doctor can be fired and replaced---often by a lesser trained medical practitioner.

While some physicians are able to escape corporate ownership by turning back to independent practice, many physicians do not have that option. This is a particular problem for doctors who require a hospital setting to work, as a 2010 law banned physicians from owning their own hospitals. Emergency physicians and hospital-based specialists have been hit especially hard by corporate ownership. These doctors are forced to tow the party line or find themselves out of work. With many doctors unable to practice outside of corporate or government ownership, the only hope for improving the healthcare system is to harness the power of the physician-patient relationship.

Patient Support is the Key

Doctors can’t do it on our own; there are just too few of us, with only 700,000 practicing physicians in the United States. Moreover, the risks for individual physicians are high, with doctors facing job loss and ostracism for speaking out. But there are far more patients, with about 213 million Americans being treated by a healthcare professional in the past year. To make positive change in healthcare, physicians must engage these patients in our mission. And when patients understand the stakes, they will rally to our cause. I know this is true, because I’ve seen it happen.

In 2018, the small town of Naples, Florida, was rocked by controversy when NCH Healthcare, the county’s largest healthcare system, threatened to eject community physicians from providing in-patient care. The hospital announced a decision to restrict in-patient care to only hospital-employed doctors, arguing that the model would improve quality of care, patient satisfaction, and shorten length of stay. Community physicians protested this change, and although the medical staff unanimously voted against the policy, the hospital administration continued to move forward with its plans.

Facing the possibility of having their hospital privileges summarily restricted, the independent physicians brought their concerns to the Collier County Medical Society, which represents 600 of the county’s 800 practicing physicians. When the hospital ignored recommendations from the Medical Society, the group decided to take the issue directly to the community. Medical society leaders met with a marketing agency to plan a public relations campaign to oppose the NCH hospital admissions policy. In just weeks, thousands of dollars were raised by community physicians and concerned citizens, allowing the group to begin a strategic multi-media assault.

The campaign focused heavily on educating the community about the NCH admissions policy and the impact of this decision on patient choice. The message was repeated in television, internet, and newspaper ads, as well as printed brochures available in physician offices. Physicians added their names to a full-page newspaper ad and wrote individual letters to the editor. Several doctors appeared on television news to discuss physician concerns.

But most importantly, physicians were able to engage patients and convince influential community members to add their voices. The mayor of Naples, the Collier County Commission, and the Naples City Council wrote letters (Freeman, L., 2018) to the NCH Board of Trustees asking the hospital to reconsider their stance. Yard signs decrying “NCH Denying Patient/Physician Choice” were posted in front of multi-million-dollar homes across Collier County. Large hospital donors pulled funds earmarked to the organization in protest, resulting in the cancellation of a $1 million biannual fundraiser event. Patients made themselves heard by writing letters to the editor and showing up at meetings and rallies, and fifteen thousand signed an online petition in protest of the policy.

The campaign continued throughout the months of November and December, with no call for compromise by NCH. In fact, the hospital doubled down on its original plan, responding with its own public relations campaign, as well as holding two town halls (Freeman, L., 2018) to explain why the self-contained hospitalist system would be better for patients.

Community physicians kept up the pressure, and patients continued to support the doctors. On January 21, a rally in downtown Naples was held to support community physicians. And on January 23, the NCH Board of Trustees asked for, and received, the resignations (NBC2 News, 2019) of the hospital’s top leaders. Community physicians, thanks to widespread support from patients, had won. This unlikely miracle occurred not by luck or accident, but from a coordinated, organized effort by community physicians and engaged patients.

Engaging Patients

In order to gain support from our patients, physicians must work together. First, we must create a clear and consistent message. We can do this by working with organized medicine groups, specialty societies, or grassroots physician groups. Next, we must communicate our message directly to patients. We can do this by personal conversations with our patients in the exam room, through social media postings, writing letters to the editor, op-eds, and through public relations and marketing campaigns.

One example of this is the group Physicians for Patient Protection, a group dedicated to promoting physician-led care and truth and transparency in health care advertising. Starting out as a secret Facebook group for like-minded physicians, the organization gained official corporate status in 2018 and created bylaws and a mission statement. In 2019, using membership dues and donations, the group hired a public relations company to bring their message directly to patients through media sources.

While most mainstream media sources did not immediately respond

References: to the group’s pitches, through consistent effort and focusing on patient testimonials, interest began to grow. In December 2019, the group began to receive queries from reporters with large media outlets like FOX News and USA Today.

As physicians, we often feel very alone when confronting large health care organizations and government policies. Effecting change seems downright impossible. But by working together with patients for a common goal, we can make a difference.

Rebekah Bernard MD is a physician in Fort Myers, Florida and the author of How to Be a Rock Star Doctor and Physician Wellness: The Rock Star Doctor’s Guide.

The Physicians Foundation (2018). 2018 Survey of America’s Physicians Practice Patterns and Perspectives. Retrieved from physiciansfoundation.org/wp-content/uploads/2018/09/physicians-survey-results-final-2018.pdf

McCarthy, J. (2018). Most Americans Still Rate Their Healthcare Quite Positively. Retrieved from https://news.gallup.com/poll/245195/americans-rate-healthcare-quite-positively.aspx

Pereira Gray, Sidaway-Lee, White, Thorne & Evans (2018). Continuity of care with doctors - a matter of life and death? A systematic review of continuity of care and mortality. Retrieved from https://bmjopen.bmj.com/content/8/6/e021161.info

Jones, J. & Reinhart, RJ (2018) Americans Remain Dissatisfied With Healthcare Costs. Retrieved from https://news.gallup.com/poll/245195/americans-rate-healthcare-quite-positively.aspx

Centers for Disease Control and Prevention. Retrieved from https://www.cdc.gov/nchs/fastats/physician-visits.htm

Freeman, Liz (2018). Residents urge Naples Council to send message to NCH about hospital admissions. Retrieved from

www.naplesnews.com/story/news/health/2018/12/05/naples-city-council-hear-angered-residents-over-nch-admissionspolicy/2213736002/

Freeman, Liz (2018). Yard signs spread in Naples area vs. HCH plan to limit doctors’ hospital admission privileges. Retrieved from www.naplesnews.com/story/news/health/2018/12/02/yard-signs-spread-naples-area-vs-nch-limits-doctors-hospitaluse/2154905002

Reye, A. (2019). Florida hospital cancels fundraiser amid criticism for admission policy. Retrieved from www.beckershospitalreview.com/hospital-management-administration/florida-hospital-cancels-fundraiser-amid-criticism-for-admissionspolicy.html

Freeman, L. (2018). NCH Healthcare System to hold community forums on admission policy. Retrieved from www.naplesnews.com/story/news/health/2018/12/17/public-can-ask-nch-leaders-admissions-policy-forums-wednesday/2339897002

NBC2 News (2019). NCH CEO resigns after unanimous vote of ‘no confidence’. Retrieved from https://www.naplesnews.com/story/news/local/2019/01/23/nch-board-of-trustees-accepts-resignations-of-ceo-allen-weiss-chief-of-staff-kevin-cooper/2661266002/