When providers can’t win, patients also lose

Many have likely experienced the following scenario in their own doctor’s offices – a physician who seems far more engrossed in their computer screen than the patient sitting in front of them, typically in various forms of undress, uncomfortably talking to a stranger about sensitive issues of health and well-being.

It is easy to fault physicians for failing the simple task of even looking at their patients during their appointments, but there are two major forces currently driving policy and rhetoric in health care. Take the simultaneous focus on “patient-centered care,” add  it to the dizzying number of requirements related to data collection and (EHRs), and squeeze both into a 15 minute office visit. Did I forget to mention the physician is also being and the office is running 30 minutes behind? In a world where change in the health care is rapid and the responsibilities of providers are piling up, isn’t it time we cut our doctors some slack?

The Institute of Medicine defines patient-centered care as “care that is respectful of and responsive to individual patient preferences, needs, and values, and ensuring that patient values guide all clinical decisions.” The promise of the patient-centered care model rests on the foundation of a strong interpersonal relationship between the physician and the patient. Only through relationship-building can providers get their patients to avoid unnecessary tests, ED visits, and build a contract of adherence.

The concept of patient-centered care is not just theoretical, but actually has legs when it comes to predicting recovery and costs. Stewart et al. demonstrated that when patients rated their interactions with their provider on a scale that measured patient-centeredness, it predicted future health service utilization and health status, whereas when physicians rated that same interaction, it had no predictive validity at all. Patients know what is good for them, sometimes more than their doctors.

At the same time, the push to expand the role of health information technology (HIT) in medicine is swift and strong. Federal meaningful use programs established by the HITECH Act reimburse providers for meeting certain benchmarks of functionality of their EHRs. However, these incentive payments are tied to increasingly demanding requirements. The latest included 17 core objectives, many of which require extensive documentation. This translates to doctor visits where it seems like the doctor is there to examine a computer instead of a human. Many of these tasks have nothing to do with patient care; more so, how can the practice, hospital, or provider bill. As part of an ongoing research project on HIT, we learned from providers in Rhode Island that EHRs increased physician take-home workload and over 60% said EHRs reduced job satisfaction.

The promises of HIT to reduce medical errors, increase coordination between providers, and engage patients is no less enticing than the promises of patient-centered care, but we can’t have a system that is not benefiting patients and is simultaneously punitive towards providers.

Most of the current EHRs are designed to ease billing – not to enhance the patient-provider experience. Moreover, the EHR market is saturated with systems that are equipped with advanced features, often underutilized since systems are not interoperable. This might mean that a lab test ordered through one physician’s EHR gets printed out, faxed, and then scanned into the EHR on the other end. Considering we can now feel our lover’s heartbeat through an Apple watch, this type of inefficiency is comical.

Both those that spout the virtues of patient-centered care and the HIT revolution have well-intentioned eyes set on the buzzword of the past 30 years of healthcare delivery: quality. Both of these reasonable, well-intentioned movements are just different sides of the quality coin, and you can’t have both at the same time.  When “quality” puts providers in situations where there is no way to win,  patients also lose.

This Policy Prescriptions^® OP/note is written by Sarah Gordon. She is a doctoral student at Brown University studying issues of U.S. health policy. She has previously worked in advocacy organizations and as a consultant for political campaigns and non-profits. Follow her on Twitter @SarahHallGordon.