By Dr. David Hanekom, MD
Note: This article originally appeared in a commentary published by the Arizona Republic, “My Turn” column, December 15, 2017
Quality, affordable health care is on virtually everyone’s mind these days.
We are living in a world of uncertainty as sweeping changes to the health-care industry
abound. As the politicians, lobbyists, insurance companies and advocacy groups advance their own priorities, I want to focus on the very heart of good health — the relationship between patients and their primary care provider — and how a mutual trust between the two affects our quality of life and the cost of our care.
Health care has always been about the relationship between physician and patient. In my view, that relationship needs to be a partnership.
As the CEO of a physician-led, clinically integrated care network, I have learned that for each aspect of care, there is a physician responsibility and a corresponding patient responsibility.
After all, patients are responsible for their health and their health-seeking behavior. Physicians are their trusted advisers. Both share a joint responsibility for the journey and both benefit from shared guidelines — some explicit, some unspoken — that make the partnership work.
Where the system breaks down.
Unfortunately, these partnerships are not working as well as they could. In September 2016, the Centers for Disease Control and Prevention reported that one in four Medicare participants ages 65 or older — about 5 million people — do not take their blood pressure medicine as directed. What’s more, 20 to 30 percent of prescriptions for chronic health conditions are never filled, and about half are not taken as prescribed.
Are patients discounting their doctors’ advice? Are health-care providers doing enough to follow up with patients? Perhaps most importantly, what can be done to strengthen the bond between patients and physicians?
I believe there needs to be trust and transparency between both parties. For patients, that starts by choosing a provider with whom to have an open dialogue and a shared responsibility for the outcomes of care.
Both parties also should talk openly about finances. Patients should ask not only about the cost of a given procedure but also possible alternatives.
Doctors: Provide options
Similarly, health-care providers should provide options. This doesn’t mean that health-care decisions should be made solely on cost; rather, it is about knowing the financial consequences of a particular health-care procedure as part of the larger decision-making process.
Physicians need to take responsibility, too, by understanding the economic implications of the recommendations being made.
Of course, none of this will matter if the patient and physician do not have mutually agreed-upon health goals. Physicians must understand where patients want to be with their health and what they are willing (and not willing) to do to stay healthy. It is up to the patient to act and together with the physician negotiate a shared outcome
Finally, care teams must step up their efforts by providing more support. When a patient doesn’t show up for an appointment or respond to a request, the physician and the care team should personally reach out to ask what happened and how they can help the patient do what’s needed to be successful in meeting his or her goals.
Now, more than ever, patients and physicians must work harder to establish a partnership. By doing so, both will reap the greatest rewards.
