March 7, 2011 
In a recent survey by Consumer Reports, 76% of physicians say that a longer-term relationship with their patients would be very helpful.
Is that feasible in today’s environment with consumers more likely to move cities and states?
Assuming it is, this would seem to make EMRs more important especially as they could act as a CRM system for the physician. The average physician probably supports about 2,000 active patients (“physician panel“). It would be difficult for them to remember and personalize their experiences without some mechanism for capturing notes about the patient. Certainly this can and has been done on paper for years, but technology would make this much more efficient.
“A primary-care doctor should be your partner in overall health, not just someone you go to for minor problems or a referral to specialty care,” said Kevin Grumbach, M.D., professor and chair of the department of family and community medicine at the University of California at San Francisco.
The article says that there is research that supports the fact that patients who stick with one physician over time have less healthcare issues and lower healthcare costs. I would assume that it therefore holds that patients who like their physician begin to trust their physician and therefore stay with their physician longer.
Physicians said that respect was the second thing that could help patients get better care. Does that mean that disrespect causes you to get worse care or simply that you’re less likely to engage the physician in a dialogue and understand their recommendation?
There were lots of surprises to me in the data:
- 33% of patients track their changes and activity between visits. I’m guessing those are the chronically ill patients with complex diseases not the average patient.
- 80% of MDs thought that patients would be better off with a family member or friend joining them for the visit…but only 28% of patients have someone with them.
- Only 8% of MDs thought that online research was very helpful with the majority of them thinking it provided little to no value.
- 9% of patients had e-mailed their physician in the past year.
- ¼ of patients indicated some level of discomfort with their physician’s willingness to prescribe medications.
Enabling Healthy Decisions 
Much of Specialty Care Spending is Unnecessary
Specialty care in the United States is the envy of the world. Dedicated professionals
spend decades in education to refine their knowledge, skill and application to make a
significant difference in medicine and in the lives of patients. Nevertheless, as a nation,
we overuse specialty care.
According to the Dartmouth Atlas of Health Care, almost one-third spending for the
chronically ill is unnecessary. It’s principle investigator, John E. Wennberg, M.D.,
M.P.H. “Variation is the result of an unmanaged supply of resources, limited evidence
about what kind of care really contributes to the health … and falsely optimistic
assumptions about the benefits of more aggressive treatment of people.”
Many high-intensity hospitals care facilities are overly used with no evidence to support
better outcomes, and may actually cause harm according to Wennberg. Dartmouth
researchers studied Medicare patients with heart attacks, hip fractures and colon cancer.
The data suggest that centers with the most high-intensity care actually have slightly
higher death rates than those with a lower intensity of care. As a result, the researchers
say, the bills for patients with similar illness may be two or three times higher at some
prestigious institutions, with no apparent additional benefit — and perhaps some risk of
harm.
High-intensity hospital cost for a certain procedure in the study varied from $30,000 to
$110,000 with the predominant influencer of cost being the volume of services available.
That is, the primary reason for the cost differences was the capacity of services, such as
hospital beds, intensive care units and specialist physicians, within the community. There
was no evidence that people are sicker in the markets of high-intensity services than in
low ones, says Wennberg. When beds are available, physicians figure out a way to fill
them.
Both doctors and patients generally believe that more services – that is, using every
available resource such as specialists, hospital and ICU beds, diagnostic tests and
imaging etc. – produces better outcomes. The evidence is lacking to support the belief.