Pauline Chen M.D., authored an interesting article in the NY Times, entitled Do Patients Trust Doctors Too Much? It is an interesting question to ask. Dr. Chen’s insight includes the following thoughts:

- In reviewing the physician ratings on Angie’s List there was a strong correlation to high ratings
for physicians based on attentiveness and bedside manner but patients rarely mentioned
medical skills as a criteria of the rating.
- Few patients actually devote any time to researching the medical credentials of a physician.
- Patients spend more time on researching job changes than they do on researching a physician
who is performing surgery on them.
- There are consequences to that type of blind trust.
- A healthy physician/patient relationship requires patients to come to the relationship educated
about their physician, their illness and treatment.

Note from Mindy: I welcome Amy Kramer, Healthcare Sector Strategist at Maritz, for her second post. With Amy’s 10 years of experience in the healthcare industry, ranging from pharmacy, hospitals, managed care, and pharmaceuticals, Amy’s thoughts are both detailed and contain real-world applications. Enjoy!

We all know nurses and physicians as the direct respondents to our care as patients. Whether we’re in a doctor’s office, or in the hospital, everyone is working on the same side, right? Not in all cases. There’s definite tension between some nurses and doctors. Nurses tend to call on patients’ needs more than the patient’s physician (as much as five times more). Physicians are under-staffed, but the nurse is counted on to be readily available to answer questions, serve the patient, serve the family and communicate back to the doctor. It could be argued in many cases the nurse may know more about the patient than the actual assigned doctor. There is also the new a new trend of “hospitalists,” an on-site doctor assigned to all “in-patients.” The hospitalist completes rounds on behalf of the patient’s actual doctor, who doesn’t see the patient until after discharge. This trend at first seems incredibly convenient, but we’re learning it’s also damaging the patient experience at times. Not all patients want to see a slew of people. They want direct access to their doctor, and when they don’t get it, it’s the frontline nurses generally taking the disgruntled heat.

In order to deliver optimal patient care, nurses and physicians must collaborate. However, more often than not, physicians see a distinct difference in their roles for caring for patients. There’s an apparent level of hierarchy, and nurses tend to receive the short end of the stick. We hear of a lack of respect, recognition and appreciation for each others’ contributions to patient care. Physicians and nurses need to find a balance in their roles and set expectations to make sure each delivers equal and agreed upon care for the patient.

It’s also imperative for physicians to recognize the strengths and skills nurses bring to the healthcare profession. Nurses have a direct impact on patient health outcomes too. Physicians need recognition for their approach to patients, as well as feedback on ways to make the healthcare environment better for everyone.

At the end of the day, both nurses and physicians want the best treatment and care for their patients. To achieve this shared goal, they need to realize they have to work through their differences and appreciate each other’s contributions. When the working environment is better for the people providing the care, patients ultimately win with a better experience and care.

There is some disconcerting news out today that indicates the U.S. is facing not only a shortage of nurse professionals but also primary care physicians. According to an Associated Press article only 2% of graduating medical school students are planning to enter into primary care internal medicine, down 7% from last year.
This troubles me for several reasons:
1) The push towards preventative care (wellness) is going to require a good deal of coaching and guidance to move patients along the continuum of change. Primary care physicians are seen as the most likely candidate to assume the role in quarterbacking and coordinating those wellness efforts. However, coaching, educating and following up with patients in an effort to drive more proactive and preventative behavior takes quite some time. With an aging population (the largest consumers of a PCP’s time) and an expectation that PCPs will quarterback wellness initiatives, the news about a shortage of PCPs is problematic to say the least.
2) The concept of the Medical Home Model that has repeatedly been discussed as the optimal model for coordinated care that can lead to better, healthier outcomes once again rests on the premise that a primary care physician should act as the quarterback for coordinating these care efforts. Without adequate capacity, and a reimbursement model that doesn’t reward PCPs for assuming these additional responsibilities this model will fail before it even begins.
3) The reimbursement model that healthplans have constructed creates a large disparity between primary care physicians and specialists which must be addressed if the U.S. is going to continue to entice med school students into primary care.