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America's Checkup - From the Patient's Perspective

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One of the basic tenants of early medical school teaching revolves around learning to listen well to the stories our patients tell. Young physicians are taught that paying careful attention to this is the first necessary step before crafting more questions and tests to arrive at a proper diagnosis. One time-honored adage is that if asked the right questions, our patient’s answers alone will suggest the correct diagnosis 95 percent of the time. With this in mind, I was particularly interested in the results of the second nationwide survey of patients published by the Physicians Foundation this month. Our aim was to identify what patients believe the key drivers are that ail American healthcare.

Perhaps most importantly, the vast majority of patients (95 percent) reported that they are satisfied with their primary care physician. This is consistent with responses to a previous patient survey we issued in 2016. Despite all of the frustrations physicians reported in the Foundation’s 2016 Survey of America’s Physicians, (49 percent of those surveyed reported symptoms of professional burnout), patients continue to be satisfied with the outcome of their visits with their physicians. So far, we have a good checkup.

More ominously, when asked who had the most influence on decisions regarding treatment options in their care, the majority of patients (69 percent), ranked insurance companies as the most significant, while physicians ranked only fourth (31 percent), falling behind pharmaceutical and medical device companies, (49 percent) and Congress (41 percent). Our patients are telling us that in reality, they believe that forces outside the exam room have more control over their care than the physician who just examined them! This is where the alarms start ringing on the monitors connected to the pulse of our healthcare system.

Consulting the most recent nationwide survey of physicians, we get a disturbing second opinion. More than 74 percent of doctors surveyed in 2016 agreed, feeling that external factors such as third-party pre-authorization, inefficient electronic health records and mandated treatment protocols adversely affected the care they were attempting to provide. Patients surveyed, however, feel that their physician should be the one advocating for them  in the often-frustrating morass of third-party red tape and regulation that has become a disturbingly large part of our healthcare system. Furthermore, our patients regard the input of physicians as very important in effecting change. Eighty-seven percent of patients surveyed believed that the voice of physicians was critical in discussions about access, costs and quality within our healthcare system.

More bad news is coming from our consultants at the bedside however. A majority (59 percent) of physicians in the 2016 survey feel that they can no longer be an effective force for change in the same areas our patients look to them for advocacy in healthcare reform.

So how do we reconcile these conflicting opinions at the bedside of our ailing healthcare system? I believe that our mentors in medical school got it right, and that we need to allow our patients to help us help them – by listening well to what they’re saying. In the survey, 87 percent of patients understood that poverty and social issues play a significant role in the costs of healthcare, while 88 percent point to rising drug costs as the main culprit in healthcare cost inflation. An even larger majority are concerned that rising healthcare costs will have an adverse impact on them personally in the future. Twenty-five percent have not filled a prescription because of cost, and three quarters of the patients surveyed are concerned about their ability to pay for care should they become ill.

Patients are telling us that they are concerned about who makes decisions in their care, the escalating costs of that care, and how it will affect them personally in the future. They realize that the perspective of their physicians will be critical in shaping a system that actually works for patients and those providing that care, and expect their doctor’s voice to be a major contributor to the ongoing debate. Our patients are holding all the stakeholders in our healthcare system accountable to work together to find solutions which will improve the financing and delivery of that care. Our physicians do hear their stories on a daily basis, and are listening. It is time our elected leaders not only listen, but work together with us to make this important patient, our healthcare system, better.