Is the New Model of Medical Practice Good for the Patient?
by Bob Kieserman
Recently, a doctor challenged me on my approach to the provider/patient relationship. He said that I am much too hard on the doctors, and that the suggestions that I make to patients in my role of Executive Director of The Power of the Patient Project as what they have a right to expect when visiting their doctor are not fair, and much too unrealistic in the present world of corporate medicine. The doctor pointed out to me, that while he totally agrees with what I believe patients should expect from their doctors and their support staffs, corporate medicine simply does not allow most doctors to do the things I am suggesting, and that we, as patients, should not fault the doctors, but rather, the big hospital systems for whom they work. He told me we need to give the doctors and their staffs a break. I thanked him for his thoughts, and I realized that he is right. As patients, we have the right to expect certain things from our healthcare providers, but in many cases, their hands are tied and they are really doing the best they can under the circumstances.
The Way It Once Was
It’s been awhile, but I remember when almost every doctor in America owned his or her office with a small staff, often just a nurse and a receptionist who very often was the spouse of the doctor. Many of the offices were scattered throughout the neighborhoods in both small towns and larger cities, and others were in office buildings near neighborhood hospitals where all of the suites were occupied by doctors. I am talking about a time when in many towns, there was a hospital in almost every major neighborhood. Most of the waiting rooms in the offices were small and quite quaint, and your wait to see the doctor was typically very short, but the time spent with the doctor often lasted 20 minutes or longer. I remember that when I had a doctor’s appointment, I was often the only one in the waiting room because that is the way the doctor scheduled patients. For many years, when I was growing up, if I was sick, the doctor even came to my house. It was aptly called a house call, and doctors had one or two days a week when they routinely made them. I really miss those days. I know a lot of doctors do also.
The Major Change in How Healthcare is Delivered
In 1990, there were 6,650 hospitals in the United States. In 2016, there were 5,530. That is because around 2010, a new chapter in healthcare management began to take place. Between 2010 and 2017, hospital systems were formed with major hospitals in various regions of the country buying smaller hospitals and/or merging with similar size hospitals to form large regional healthcare systems. And as part of the game plan of the hospital systems to become the major supplier of healthcare, doctors in private practice were approached to sell their practices to the healthcare systems. At first, many doctors, especially older very established private practitioners, resisted, but the offers by the hospital systems were so lucrative, that the doctors accepted the offers. Some of the older doctors retired at that point, while others who wanted to continue to practice medicine became employees for the first time in their medical careers. For those doctors, life became very different. No longer were the doctors making decisions about the business operations of their practices. That now became the responsibility of the hospital systems who took over. The doctors were employees and their job was just to practice medicine. The hospital systems took care of everything else. At the same time, the hospital systems placed many protocols on the doctors and their staffs. Important protocols like how much time a doctor should spend with a patient, how many patients the staff needs to schedule in a certain day, whether a patient should see a doctor or a physician assistant or a certified nurse practitioner, and many other rules that became the universal protocols of all system-owned offices. At the same time, not only the hospital systems were growing, but also for-profit healthcare corporations who owned hospitals and created their own network of employed doctors. Over the past two years, the hospital systems and these for-profit corporations have continued to grow even larger, but the big question is whether this change has benefited the patient or whether it has not.
A recent study by the Physician Advocacy Institute and Avalere Health, a consulting firm, found that the pandemic actually accelerated this trend of corporate medicine acquiring physician practices with over 25,000 physicians leaving their private practices and joining these hospitals and companies since the pandemic began. It is estimated that in the beginning of 2021, nearly 70% of physicians were employed with just 3 out of 10 doctors still practicing independently.
The Doctors Are Not Happy
Late last year, the Physicians Advocacy Institute sent an open letter to members of Congress to warn against this “major shift toward the corporatization of healthcare”. According to the open letter, if Congress did not take action to monitor the activities of these big hospital systems and prevent them from reducing the clinical autonomy of doctors to provide high-quality, cost effective care for patients, this could have major implications for the overall American healthcare system and definitely affect the welfare of patients across the country. This is the real issue with the change to corporate medicine – that doctors have lost the ability to practice medicine as they were trained to do and to make clinical decisions for the good of the patient, and not for the good of the bottom line of the companies that now own their offices.
How This Affects Patients
It has been said that the big hospital systems and the for-profit healthcare companies, because they are seeking high financial returns in reimbursements and fees for service, have pressured their employed doctors to see patients more often for followup visits, order more tests that the third party insurance companies will pay for, push for virtual visits rather than live in office visits, since they can charge the same for a virtual visit as they do for an in-office visit, but the virtual visit usually ends up being shorter and easier for the doctor, and scheduling more appointments with the PA or the CNP instead of the doctor, but charging the same for the visit. Patients have also complained that doctors spend more time looking at the computer during a visit, than talking to the patient and examining them. This is due to new protocols connected with the use of electronic medical records. Because many offices are scheduling three patients or more for the same appointment time, the doctor is rushed and in some cases, no longer fully examining a patient, as they once did. I have come to learn and appreciate that the doctors are not happy with the situation. They are doing the best they can, but they know they are not giving their patients the same personal attention they once did. In some cases, this new way of practicing medicine has caused physician burnout with many excellent doctors retiring earlier than planned or leaving medicine altogether and getting into a different career path. For many older patients, in particular, the doctors who have cared for them for decades, are deciding they have had enough, and are retiring, leaving the older patients to find new doctors and start new relationships late in life, when they need doctors the most.
What Can Patients Do?
There are really two major things patients can do to help the situation. The first is to be understanding and verbally support your doctors. Tell them how much you appreciate them, tell them that you understand they are under new pressures that they never had before, and try to be less demanding on what you know should be, but just can’t be right now. The other thing that patients can do is to let the hospital systems and/or the healthcare companies know that you value your doctors and that they need to give as much autonomy to the doctors as they need to practice medicine the way the doctors want for the benefit of their patients. Patients can make a difference. The large systems and corporations are big on surveys. They send them out all of the time, especially after an office or virtual visit. Be sure to be honest about your experiences and let them know that doctors, even though they are now employees, need to be able to practice medicine with full decision making powers, deciding what is best for the patient including what tests need to be ordered, what specialists they need to see, how often they need to return for followup visits, and how necessary it is for certain medications to be prescribed or not prescribed.
Together, we may be able to change the way our healthcare is being delivered. But we need to be proactive with the systems and let them know how we really feel and be understanding and supportive of our healthcare providers, and let them know we care about them and want there to be changes.
Bob Kieserman is the Executive Director of The Power of the Patient Project: The National Library of Patient Rights and Advocacy, and publisher of Today's Patient. Now retired, for over 35 years, he was a professor of healthcare administration and medical ethics and a healthcare consultant. He is the author of over 300 articles and four books on managing the private healthcare practice, the patient/provider relationship, and the rights of patients. Bob is both a medical librarian and a medical sociologist and resides near Philadelphia.
How to Cope with Anxiety When It's Time to Visit the Doctor
by Julianna Strano
Visiting the doctor's office can bring about a mix of emotions. From the process of scheduling appointments to fit within our schedules, to wondering what the clinical outcome will be, to the time spent in the waiting room, feelings of nervousness and stress are common for many individuals.
The Issue of Iatrophobia
The Cleveland Clinic defines the fear of doctors and medical tests as “iatrophobia”. A survey found that even if they feel care is needed, about 1 in 3 Americans will avoid going to the doctors office. According to The Cleveland Clinic, “Iatrophobia causes you to fear doctors or medical tests. You may avoid seeking medical care even when you’re very sick because you have extreme anxiety or panic attacks.”
What to Do If You Are Anxious
James Wang is a gynecologist who has been a physician for almost 30 years. He explains that individuals may be anxious when they go to their doctor because they don't know what to expect. The anxious feelings also depend on why they are at their appointment. For example, if patients are experiencing symptoms that they are concerned about, anxiety is more common. Fear of the unknown is common, so going to an appointment not knowing the outcome or diagnosis can cause fear, worry, or concern. These are normal human emotions and reactions.
According to Dr. Wang, when visiting the doctor, it is helpful to express your concerns and feelings; explain why you are nervous or stressed about the visit.
“If someone is going in for an annual visit,” Dr.Wang explains, “and they have specific questions, they should write them down to remember to ask the doctor about their concerns.” And if patients are experiencing specific symptoms Wang suggests that they focus on what is bothering them most.
Working with Your Doctor As a Partner
Dr. Wang also explains how it is helpful to remember that our doctors are people just like we are.
“I think looking at your doctor as a person can be helpful. Don’t necessarily presume that the physician is sitting on a pedestal and mediating out medical information. I always look at taking care of my patients as a partnership. Don't look at it as if they (doctors) are going to tell me what to do, look at it as a partnership and work as a team to make sure I (the patient) stay healthy,”
When thinking of office visits with your doctor as a partnership in healthcare, it is important to remember that both the doctor and the patient should be doing their part. The doctor gives the patient advice and the patient should follow it. Compliance is most important from the perspectives of both the doctor and the patient.
Working with your doctor as a partner in your healthcare will improve the patient’s prognosis and also foster a good ongoing relationship with your doctors.
Julianna Strano is a senior at The University of Arizona majoring in journalism and sociology. Julianna is passionate about all topics related to health and wellness and has the goal of educating and informing others through her writing. Julianna joined the editorial staff of Today's Patient to have the opportunity to help educate others on patient rights and discuss topics that she is passionate about.
The Benefits of Mindfulness
a personal connection
by Hailey Hough
I once read a quote that stated, “Anxiety is living in the future, depression is living in the past, and peace is living in the present”. Living in the present sounds simple enough until you realize your brain is constantly only thinking about future events or past experiences. Even in the moments where you feel amazing, there’s still an idea in your head of “What’s Next?” or even dwelling on something that happened moments earlier. It almost feels impossible to not think about anything else except the moment you are in.
Part of me feels as if we were trained to think like this because there’s almost this sense of guilt that comes with not thinking proactively about the next steps (long-term or short-term) when you’re in a situation. I believe we are wired to think that any moment spent not thinking about the future we are “flat-lining” in our personal life journey. I can compare this to the idea of describing someone having the tendency of “Living in the moment” is almost perceived as a bad thing, or at minimum has some sort of negative stigma when measuring how successful that person will be. You might plan a vacation and spend every day excited thinking about all the fun you will have. However once its happening, you will be thinking about where you’re going to go for dinner later, what you should wear tomorrow, etc. and never actually find yourself in that moment enjoying what you were looking forward to for so long. With this happening, we never get to live out all the things we look forward to because we are too caught up in the stress of the future or pressure of the past.
What is Mindfulness?
Mindfulness is defined as “The practice of maintaining a nonjudgmental state of heightened or complete awareness of one's thoughts, emotions, or experiences on a moment-to-moment basis”. It has also been stated that mindfulness is “a mental state achieved by focusing one's awareness on the present moment, while calmly acknowledging and accepting one's feelings, thoughts, and bodily sensations, used as a therapeutic technique”. Overall, mindfulness is described as the awareness of your present moment and the appreciation of all the feelings that may come with it.
The Evolution of Mindfulness Training in the United States
Mindfulness is used a lot in meditation, yoga, and other mental strength practices as a way to clear your mind and improve your mental health. Perhaps the biggest influence on bringing mindfulness from the East to the West was Jon Kabat-Zinn. Kabat-Zinn founded the Center for Mindfulness at the University of Massachusetts Medical School and the Oasis Institute for Mindfulness-Based Professional Education and Training. This is where Kabat-Zinn developed his Mindfulness-Based Stress Reduction (MBSR) program, an eight-week program aimed at reducing stress. He learned about and studied mindfulness under several Buddhist teachers, including Thich Nhat Hanh (an influential and popular figure in Western mindfulness himself). This gave him an Eastern foundation in mindfulness that he integrated with Western science to develop MBSR. Today, Kabat-Zinn’s program serves as the basis of many mindfulness programs provided primarily by major medical centers throughout the country.
My Personal Connection to the Benefits of Mindfulness
I began digging into the power of mindfulness when my aunt had been diagnosed with breast cancer a few years ago that she believed was stress-induced. She was certain that she did not want to undergo any chemotherapy, regardless of her doctor’s recommendation, and insisted on using natural remedies and practices to treat herself. She used supplements, essential oils, and meditation to treat her diagnosis and when she went in for her checkup, to her doctor’s surprise, the size of her cancer had shrunk to a size they were able to remove surgically. My great aunt had been diagnosed with cancer at an old age and had a similar experience. The cancer was so developed that her only option was chemotherapy which was not a relief considering the damage the treatment does and how old my great aunt was. As my great aunt waited in her private room prior to her first chemo treatment, she went into cardiac arrest and was rushed to the emergency room. After treating her heart, they assessed her cancerous tumor and found that it had miraculously shrunk down to a size that no longer required any chemotherapy. When her daughter asked her what happened in the room before she went into cardiac arrest, she said she meditated to try and clear her mind.
We know mental health in many of cases is directly correlated with your physical health, and a lot of diagnoses are stress induced, if not assisted. A Harvard study showed that mindfulness helps improve mental health, lower stress and blood pressure, improve sleep cycles, treat heart disease and chronic pain and even alleviate gastrointestinal problems. However, I believe there is an unknown power to mindfulness and for that reason the benefits are unlimited. Patients throughout the world are trying mindfulness as a practice, and are benefiting from it in many ways. You can learn more about mindfulness at https://www.mindful.org/meditation/mindfulness-getting-started.
Hailey Hough is a hardworking Advertising Management Communications major at Michigan State University and supports this with a minor in Business. She is also an accomplished journalist, driven and determined to provide the best content that will educate and spread awareness on patient rights and advocacy by creating intriguing content. She writes about topics that matter the most to patients.
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