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Expect bumps as docs try to focus on patient satisfaction

Dan Gorenstein Oct 16, 2015
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There are certain phrases that just sound good, but when you stop to think about them, it’s not clear at all what they mean.

In health care, one of those is “patient-centered.”

A new report out Friday from the Urban Institute takes a hard look at “patient-centered care,” a key concept in Obamacare.

Lead author Michael Millenson said that the term “patient-centered” appears in the Affordable Care Act some 40 times. It can often be short hand for “We care about our patients,” he said.

But as we move away from happy talk to the world of regulations, Millenson warns we must be careful as doctors and hospitals start to get paid, in part, based on patient experiences.

“Your physician is obligated by ethics to have a compassionate relationship with you,” he said. “If we start to mix in economics and profit motivations with what’s clinically best, we get a volatile mixture, and really nobody knows where that’s going to lead.” 

Millenson worries if we aren’t careful, the lines between “do no harm” and “the customer is always right” will blur.

A perfect example of that is the new expectation that doctors engage in shared decision-making with their patients.

Brigham and Women’s cardiologist Dr. Lisa Rosenbaum said she’s spending lots of time figuring out how to make tough decisions with her patients.

And while Rosenbaum said she’s all for factoring in her patient’s values, she’s concerned about losing knowledge for “a seemingly virtuous approach” to improved communication.

“There is this tremendous disconnect between the billions we invest in research to know the best things to do, and then when it comes to communicating, we are willing to say, ‘Oh, all right, we’ll just let the patient decide,’” she said.

Rosenbaum said giving the patient too much say in certain instances could lead to making poorer long-term decisions. And that could lead to additional and unnecessary costs, and most importantly, risking that person’s health.

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