It really is about the doctor patient relationship

Patients More Worried About Clinician Relationship, Access to Care Than Technical Errors

Unlike physicians, who worry more about breakdowns in how medical information is transferred or whether treatment errors occur, patients are more concerned about breakdowns in the patient-clinician relationship and access to care, a new study finds.

In fact, 37% of the 221 problematic incidents described by patients during telephone surveys cited breakdowns in the patient-clinician relationship, such as disrespect or insensitivity or inadequate time spent. Nearly one third (29%) cited access breakdowns as their chief concern that could lead to a preventable medical error, such as an excessive office waiting time or lengthy delays in obtaining an appointment with a clinician. About one quarter (24%) of the respondents cited technical errors, such as a deficiency in a diagnosis or treatment and follow-up. The study appears in the July/August issue of the Annals of Family Medicine.

The findings “resonated with my own experience and worries about what is wrong with our health system,” lead author Anton J. Kuzel, MD, MHPE, professor and chair of the Department of Family Practice at Virginia Commonwealth University in Richmond, told Medscape. “If this has resonance with people, it may push the debate about what constitutes problems that deserve our attention, and what is worthy of attention,” he said.

So how do we design a health system which rewards this relationship? Many critics of the US system hold up a variety of foreign countries that have socialized medicine, but my readings (at least of Great Britain) suggest great dissatisfaction from primary care providers.

Relationships take time. Service takes time. As long as we expect to pay primary care physicians like assembly line workers, then we cannot expect to satisfy patient needs. We can see large numbers of patients per hour, but we cannot deliver excellent service. And the way I read our patients’ desires, what they want is first class service.

What patients want is retainer medicine! They want access when they want (need) access. And we actually would like to provide that access.