Patient isolation is affecting healthcare delivery

Healthcare delivery is traveling along the same road of interpersonal interactions as all other aspects of our lives. The examples are numerous. The younger generation receives most of its information through a mobile device and utilize text as the preferred medium of communication. When we shop at the grocery store, we used to have a pleasant conversation with a highly competent employee when we checked out. Today, we slide bar codes across a computerized scanning system that calculates the cost of our purchases as we self bag our items. When we seek information by utilizing our phone as an actual telephone, we most likely, sometimes to our frustration, talk to a computerized voice system instead of a person.

A renowned physician,  Dr. Schimpff and his co-author Harry Oken, M.D. wrote in an article for Medical Economics:

There is a crisis in primary care and that crisis is now flowing over into the hospital when a primary care physician’s (PCP) patient is admitted. No longer cared for by the PCP, the role has largely fallen to the hospitalist. There has been a loss of the long time primary care physician/patient relationship, the trust that comes with time. There is been a frequent loss of satisfactory communication when the patient is admitted and again when discharged. At a time when the patient most wants and needs the comfort of a long-time trusted, professional friend, the patient instead is confronted with a stranger at the helm. What has happened to create this state of affairs?

In many ways, this is symptomatic of how we live today. Medicine and the delivery of care is now seems to be following the pattern of elimination of the interpersonal relationship between physician and patient. Dr. Schimpff continued:

The PCP was always the backbone of American medicine. He or she not only cared for patients in the office but also collaborated with the emergency room physician and attended to hospitalized patients, seeking specialist consultation as needed. Today, only a few PCPs even visit their hospitalized patients, relying entirely on the hospitalist and the emergency medicine physician.

More discouraging is the finding that hospitalists tend to place primary care doctor’s patients often on wrong medication, very often there is inadequate communication between the hospitalists and the primary care physician to review details at the time of admission. This of course can lead to a more extensive hospital stay. To compound the problem, the hand-off to the PCP at discharge is often problematic with inadequate communication between them. The PCP may not even know that the patient was admitted or discharged until the patient calls for a new appointment. Meanwhile, the fine balance of those chronic illnesses may be out of kilter so that, not surprisingly, about 20% of older individuals end up back in the hospital with an unplanned admission within the following month.

he PCP is being marginalized. This is distinctly to the patient's disadvantage.

– Dr. S. Schimff

We can see the next generation of communication between physician and patient will be similar to the hospitalist model as many companies have emerged that give you access through tele-medicine or video to a physician who does not know you as a patient. In addition, technology is available  that will allow your hand-held phone to transmit important medical data. This can be useful and quite valuable but also increase the risk of further isolation between physician and patient. Most outstanding physicians with whom I speak indicate that a very good history and physical provides them with 80% to 90% assurance of an appropriate diagnosis. What they are really saying is that the interpersonal experience between a skilled physician and his/her patient provides the doctor with the nuances necessary to fully understand the patient’s needs.

Watching the trends in medicine, I am more convinced than ever that having personal healthcare management  that has the patient’s health records and is available to communicate on an interpersonal level is the indispensable link between the patient and the healthcare delivery system. It is why we started Curus and built it on the foundation of a proactive, patient-centered business model that provides a human link to the technology explosion in healthcare delivery. We believe as the healthcare delivery process becomes driven by more increasingly sophisticated technology, the need for a company focused on the human side of the care process is increasingly more essential.