The doctor-patient relationship is under attack and, in many ways, has surrendered to an onslaught of technology, new business models and changing rules, regulations and reimbursement. <\/p>\n
In a lot of ways, doctoring is about winning the hearts and minds of patients<\/a> in an effort to get compliance with treatment recommendations. It is not working. Half of patients don’t take their medicines the way they should.<\/a><\/p>\n According to a meta-analysis published in the Annals of Internal Medicine<\/em>, Americans are failing to comply with medical prescriptions for a variety of reasons — and it’s costing them anywhere between $100 billion to $289 billion a year.<\/p>\n In some 20 percent of cases — and as many as 30 percent — prescriptions for medication are never filled. Up to 50 percent of medications aren’t taken as prescribed.<\/p>\n The doctor-patient relationship started going south a long time ago due to:<\/p>\n 1. Increasing subspecialization not just in a given specialty, but in practice locations as well…intensivists, hospitalists, teledocs, etc.<\/p>\n 2. Technologies, like telemedicine, that disintermediate a primary doctor <\/p>\n 3. Multiple dropped hand offs between one practice setting or doctor and another e.g. being seen in an emergency room and getting a follow up appointment with another doctor somewhere else.<\/p>\n 4. The erosion of trust between doctors and patients as the power shifts and patients get more information and transparency.<\/p>\n 5. Teams taking care of teams leading to confusion about who is running the show, particularly in complex, high acuity care in an ICU<\/a><\/p>\n 6. Medical travel using an ecosystem that does not integrate care or facilitate care coordination.<\/p>\n 7. Patients deferring care due to high deductibles and copayments.<\/p>\n 8. Fraud, waste and abuse<\/p>\n 9. A general lack of civility and consideration of each other’s time. Patients don’t show and don’t tell. Doctors don’t show and make patients wait.<\/p>\n 10. Commoditized care and the inability of patients to get a straight answer when it comes to price and outcomes of care.<\/p>\n