Doctor-Patient Relationship is An Endangered Species is not a blog about medmal rates or any issue related to medical malpractice–at least not as far as I can tell from what Dr. Ben Brewer writes. But I can’t help but think that this should be considered a factor.

One of the joys of being a family doctor is the relationships that I’ve developed with my patients over the last 10 years. It’s the source of energy that keeps me going after a night up delivering babies or a day of business hassles. The sense of being needed and contributing to the fabric of the community is the best job satisfaction there is.

My patients have pulled the family van out of a snowy ditch, towed my old Honda Civic to town when it broke down, shingled the roof, put windows and doors on the house, installed a new fridge after lightning zapped the house last month, and brought food to the office.

Probably not every doctor had such nice tales to tell, but I don’t find it hard to believe that there has been a dramatic shift.

Having a long-term personal physician who knows your medical condition as well as your quirks and your family is a rarity these days. With an ever-shifting array of preferred providers and insurance panels, plus a proliferation of retail clinics, staying with one doctor for long may seem like a throwback to another era. The relationship between physician and patient, like the family farm, is endangered. In some places, I’d say it’s already extinct….

The doctor-patient relationship started to go downhill when patients stopped paying their own office bills for routine care and third-party insurance and Medicare became the driving forces. That was before my time.

Now primary-care doctors are pressured to churn patients through the office, to the detriment of relationship-building and possibly the health of their patients. At the same time, patients may have to switch doctors because of changes in their insurance.

Brewer spells out some drawbacks about this shift that has taken place. It seems to me that he might add a couple, the likelihood to litigate and the likelihood for juries to award high penalties for non-economic losses. After all, medmal attorneys readily admit that they get patients in their offices who want to sue over alleged malpractice when the real issue is a lack of communication. Now, medmal insurance companies even provide doctors with training on how to communicate with their patients so that they make litigation less likely. If one accepts that interpersonal communication is important to avoiding such conflicts, then an environment in which “primary-care doctors are pressured to churn patients through the office, to the detriment of relationship-building and possibly the health of their patients,” does not sound like it is conducive to communication.

The irony would be that the demand for managerial efficiency in the office is actually more costly in the long run.

Hat tip: KevinMD