What relationship?

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.

In a lot of ways, doctoring is about winning the hearts and minds of patients 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.

According to a meta-analysis published  in the Annals of Internal Medicine, 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.

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.

The doctor-patient relationship started going south a long time ago due to:

1. Increasing subspecialization not just in a given specialty, but in practice locations as well…intensivists, hospitalists, teledocs, etc.

2. Technologies, like telemedicine, that disintermediate a primary doctor 

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.

4. The erosion of trust between doctors and patients as the power shifts and patients get more information and transparency.

5. Teams taking care of teams leading to confusion about who is running the show, particularly in complex, high acuity care in an ICU

6. Medical travel using an ecosystem that does not integrate care or facilitate care coordination.

7. Patients deferring care due to high deductibles and copayments.

8. Fraud, waste and abuse

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.

10. Commoditized care and the inability of patients to get a straight answer when it comes to price and outcomes of care.

Also, creating a patient relationship is increasingly difficult given a general lack of societal loyalty and rules that reward doing things, not building relationships. Thirdparty intermediaries also create friction leaving the patient to think their doctor is clueless when it comes to their financial or social situation.

The doctor-patient relationship has therapeutic value in many instances. Most of the time, however, you probably have a better relationship with the check out guy at the grocery than whatshisname who treated you in the ER the other night.