Internists call to end “assault” on doctor-patient relationship

The American College of Physicians releases a multipronged plan to improve the state of the nation’s health care system.

By — Posted March 1, 2013

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Payment and coverage expansion reforms to the health care system won’t succeed unless physician-patient relations can improve, the American College of Physicians concluded in a new policy paper.

“Physicians and patients are challenged by seemingly relentless intrusions into their relationship,” said Bob Doherty, ACP’s senior vice president of governmental affairs and public policy. “None of us want our doctors to be rushed from patient to patient, from task to task. If this is the system we have, then the system needs to change.” He spoke during a Feb. 20 conference call to assess the report’s findings (link).

In some respects, it’s the best of times for health care in the U.S., with more people set to obtain coverage starting in 2014 under the Affordable Care Act, Doherty said. However, “resistance in many states to expanding Medicaid and setting up exchanges [is] affecting the poor,” he said.

In its paper, the ACP called for a renewed commitment to implement coverage expansions of the ACA, with particular attention to ensuring access for low-income patients. States that haven’t expanded Medicaid should reconsider, Doherty said. “Expanding Medicaid is the ethically, morally, medically and economically right thing to do.”

The ACP also cited the continued obstacles to care brought on by Medicare’s sustainable growth rate formula, the toll of deaths and injuries from firearms, and the growing shortage of primary care physicians.

In its report, the organization made recommendations to remedy these conditions, such as repealing the SGR, enacting reasonable controls on access to firearms and improving access to mental health services. All payers should contribute to funding graduate medical education “as a public good,” Doherty said. Primary care doctors also should be compensated better so their payments are more on par with other specialties, he said.

Relationships called key

All of these proposals by themselves, however, will not improve the quality and affordability of health care unless “there’s an end to the unrelenting assault on the physician-patient relationship,” Doherty added.

ACP President David L. Bronson, MD, outlined some of the barriers that physicians face in taking care of their patients, such as a lack of time, electronic health records that don’t meet the needs of both physicians and patients, the growing number of punitive mandates on doctors, and performance measures “that can result in unintended adverse patient care consequences,” he said.

Many physicians have been leaving the profession, or are regarding primary care as an undesirable career choice, Dr. Bronson said. At its House of Delegates Interim Meeting in November 2012, the American Medical Association approved several policies to bolster the primary care work force and oppose federal cuts to graduate medical education programs. The AMA also has been calling on Congress to lift Medicare’s cap on funded GME slots.

In its recommendations, the ACP stated that any payment reforms should foster the goal of allowing physicians to spend more time with their patients. In addition, reforms that hold physicians accountable for care outcomes should avoid micromanaging physician decision-making processes if doctors and their practices can demonstrate good results for their patients, Doherty said.

The ACP also recommended ways to encourage physician participation in quality reporting programs and improve the functional capabilities of EHRs.

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