Guarding the patient-physician relationship amidst seismic change

A young man with a thoracic aortic dissection on Christmas day whose life we saved and who returned the following year to say thank you. A fellow physician become patient in whom I found an uncommon abdominal cancer and who sent me annual letters for many years to thank me for the “considerable role I played in the miracle of his life.” An elderly woman seeking relief for severe back pain whose daughter took the time to write me a thank you letter in gratitude for the relief I was able to provide her mother. These are just a tiny sampling of memorable and touching patient experiences from my emergency medicine practice.

These stories are not unusual. Every one of us who is a physician or medical student can recount their own experiences with patients that have left their mark. And that is at the heart of why we practice medicine—that patient-physician relationship.

I recently was able to share my thoughts on this topic when I returned to my hometown of Cleveland to give a talk at the City Club. These homecoming trips always make you notice how some things change and some stay the same, so it was appropriate that change was the topic of my talk.

Specifically, I addressed the seismic changes occurring in our health care system and how important it is that the centrality of the patient-physician relationship is not compromised in the midst of this transformation.

One obvious driver of sweeping change is health care reform, which has led to many more patients becoming insured and physicians adopting new models of care. Technological advances are another big influence on our environment.

In just one example of how technology is redefining aspects of the physician-patient relationship, I shared how the internet has vastly increased the information patients have at their fingertips.

Simply by swiping their smartphones, patients today can obtain information that once only physicians could access. And by wearing fitness trackers and other health devices, they can gain insight into key metrics of wellness and become more empowered to improve their own health.

In this time of truly monumental change, the physician-patient dynamic is bound to evolve. Yet the special relationship between patient and physician has been at the heart of health care since antiquity and no matter the advances in technology and changes in care delivery, the centrality of the patient-physician relationship will not change.  To this end, the AMA has embarked on multiple initiatives to ensure that the bond between physician and patient remains strong and central.

In Cleveland, I highlighted the AMA’s three bold strategic initiatives, which I refer to as our “moon shot” projects: Improving patient health by reducing the precursors to chronic diseases, creating thriving physician practices and forging the medical school of the future.

As part of our Improving Health Outcomes initiative, we’ve been working with the YMCA and the Centers for Disease Control and Prevention (CDC) to help patients with prediabetes adopt and sustain lifestyle changes that reduce their likelihood of developing type 2 diabetes. Its goal is identifying more patients with prediabetes and connecting them with the Y’s programs to maintain and improve their health, all while keeping their physicians in the loop as to their progress.

The AMA spent the past year working with the YMCA of the USA and 11 physician practice pilot sites in four states to increase physician screening and testing for prediabetes, and referral of patients with prediabetes to diabetes prevention programs offered by local YMCAs, which use the CDC’s evidence-based National Diabetes Prevention Program. 

This work helped inform Prevent Diabetes STAT: Screen, Test, Act – Today™, a multi-year AMA and CDC initiative that helps physicians refer patients to diabetes prevention programs in their communities and online.

Another effort underway is with Johns Hopkins University, to prevent cardiovascular disease by enabling patients to better control high blood pressure. Working with physicians and care teams across 10 clinics, we have created tools they can use to Measure accurately, Act rapidly and Partner (M.A.P.) with patients, families and communities.

At the same time that health outcomes programs are encouraging physicians to proactively engage with patients, physicians also are facing mounting administrative burdens and other obstacles that stand between them and spending time on direct patient care.

So, the AMA is partnering with Dartmouth Hitchcock to better understand how physician professional time is spent in typical medical practice. This really matters because we know that physicians are happiest when spending time with patients, and patients have better outcomes when their physicians are able to focus on their needs.

But this study is just one part of the picture. We’re pursuing advocacy at the state and federal levels to help alleviate burdens. Physicians already can refer to online practice transformation modules and tools designed to help.

One thing that has not changed enough over the last century is the structure of medical education. The AMA’s push to help create the medical school of the future now is entering its third year. Already, the first 11 schools to take part have used AMA grants of $1 million each to introduce exciting innovations related to creating flexible competency-based pathways, teaching health care delivery science, managing health information technology, working with the health care delivery system in novel ways, envisioning the master adaptive learner and more.

Now, the AMA is funding another $1.5 million in grants to bring on board as many as 20 additional medical schools to expand the Accelerating Change in Medical Education Consortium and further advance these transformational changes.

The AMA is committed to furthering the patient-physician partnership not only through large-scale initiatives like these but by helping to foster greater engagement and dialogue in medical offices, online or via social media.  You, too, can follow the discussion on Twitter at #AHealthierNation.

And this engagement is work that I know physicians are eager to do. Today, physicians still say they enter and remain in the profession primarily because of the deep satisfaction that comes from interacting directly with their patients.

This is further evidence of the powerful nature of the connection between patients and physicians. I am confident that, working together, we can ensure this bond endures and grows stronger as we chart a course toward a healthier future.