Nahum Kovalski

And the Race is On …

Countless times, I have read about doctors desperate attempt to maintain and further develop the doctor-patient relationship. I have also heard very often, that present day remuneration for medical care makes it impossible to devote more than 5 to 10 minutes per patient. Even if the patient presents every month to the doctor, this is insufficient time to fully connect and thereby appreciate the entire story of that patient. We were taught in medical school that a patient will effectively tell you the diagnosis, if you listen long enough and intently enough. It appears that many doctors feel that they will never achieve the necessary link to the patient in order to fully appreciate not only the diagnosis, but the contributing factors to it. Without this complete picture, patients may very well be treated for years for a disease that they do not have or that could be cured at any time.

I think the time has come for doctors to admit that the doctor-patient relationship is far more of a dream than a reality. Once this bitter truth is accepted, both the medical and patient community can look to finding alternate solutions for providing appropriate healthcare. My personal belief, as I have stated a number of times, is that there are effective and satisfying solutions to providing high quality healthcare with minimal involvement of the physician. Perhaps the first thing that we should do is change the term “doctor-patient relationship” to “healthcare relationship”. Just this simple change will immediately alter everyone’s perspective, and open the door to a whole range of alternatives that create a welcoming and productive patient experience.

Recognizing that the doctor-patient relationship is outdated, effectively nullifies the points made in this article. To be honest, I think it is ridiculous that a physician should be advising patients to choose their words carefully in order not to offend the physician. Perhaps there is not time for a doctor to sit and truly listen to a patient. But the doctors themselves should be painfully aware of this and should recognize that their patients are uncomfortable with their management. It should be the doctor who even apologizes for the fact that he or she did not inquire further into the patient’s history and concerns. It should be the doctor who finds alternate ways to reach out to the patients and to offer them a post visit opportunity to speak their mind. And finally, it should be the doctor who offers the patient to sit with the nurse or practice manager to continue the discussion and potentially uncover critical clinical information. In summary, if the doctor-patient relationship is not achievable, why should it fall to the patient to compensate for this. In this article, the author clearly leaves the responsibility for a better interaction with a physician, at the patient’s door. In my opinion, this article excuses doctors for their failure to create healthcare alternatives.

I am also very bothered by the fact that this article does not address technological alternatives for each of the five points raised. Communication with the doctor should not start and end with the appointment. A low-tech solution like email can allow a patient to prepare a list of questions and concerns that the doctor can read before the patient arrives. In the same way, follow-up after the appointment should include an automated email from the doctor’s office, that asks the patient if there are any further questions or need for clarification on what was said during the appointment. In time, the doctor will learn what specific issues are of the highest priority to the patient, and these can be the focus during future appointments. This will unquestionably increase efficiency.

The same system of emails can be used to interact with the office nurse or practice manager. In fact, it may be cost efficient to even hire an additional staff person to deal with nothing but email communications with patients. I believe the patients will naturally understand that the doctor visit is for key issues and questions, and that anything else falls into the domain of alternative health professionals. And it is these alternative professionals who will be available for additional discussion, whether in person or by email.

If the patient still feels that they wish to move to another physician, this should be respected and even assisted. The patient should be able to access online a complete copy of their medical charts along with any personal notes that their doctor has added to the chart. When meeting with the new physician, the patient should only need to provide a temporary or specialized access code so that the new physician can get up to speed on the entire medical history. Perhaps, the previous physician should even provide a list [by email] of other primary care physicians in the area. If the patient, who is leaving the practice, would have access to all that I have described above, it would dramatically reduce the stress of such a move. Perhaps, if a physician realized how easy it is for a patient to change doctors, the first physician would make a greater effort to address the patient’s needs.

The time will come when patients no longer tolerate inadequate care. Technology will allow patients to know that they have alternatives, and will make these alternatives readily available. As much as doctors claim that medicine is an art and that they treat patients, not “business clients”, doctors will have to make major changes in their practices, if their patient load significantly dwindles.

Without getting into the whole discussion of the economics of medicine, what I am describing is simply market forces at play. If customers are not satisfied with the present set of products, someone will create a new product that the customers flock to. If present-day physicians cannot provide adequate health care for what ever reason they have, someone will come up with an alternative that is financially viable and that satisfies the customers/patients.

Doctors are absolutely not used to working in such an environment. But they will have to adapt in order to survive. I would also say that medical schools need to realize the effect of the new world, and teach doctors that medicine and healthcare will soon be commodities that they no longer have a monopoly over. It is amazing how innovative people [and doctors] become when their income is threatened. As such, I actually have hope that healthcare will dramatically improve, including that part which is delivered by human physicians.

Thanks for listening

About the Author
Dr. Nahum Kovalski received his bachelor's of science in computer science and his medical degree in Canada. He came to Israel in 1991 and married his wife of 22 years in 1992. He has 3 amazing children and has lived in Jerusalem since making Aliyah. Dr. Kovalski was with TEREM Emergency Medical Services for 21 years until June of 2014, and is now a private consultant on medicine and technology.
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