The ongoing transformation of medical care from a cottage industry to a corporate business model has had many unfortunate effects on the doctor-patient relationship. Perhaps the most striking change is the amount of time physicians are able to spend with their patients. The average American spends approximately 30 minutes a year with a primary care physician http://www.ucsf.edu/news/2007/06/5592/comparison-study-shows-us-low-primary-care-physician-visits, and the average duration of a visit to a specialist in internal medicine lasts about 20 minutes
In addition to time-limited visits, the increased difficulty in getting timely appointments and the increased likelihood of seeing an assistant, a family practice nurse or physician’s assistant rather than the doctor, are some of the other effects of the limitations on allowable charges reimbursed by medical insurance carriers.
These changes restrict the patient’s ability to discuss the full spectrum of options concerning their condition with their physician. This is perhaps the most alarming change for the patient, many of whom may have too little information about their diagnosis to make intelligent decisions about how, by whom and where they should be treated. In hopes of filling in the gaps in their knowledge base, patients turn to family and friends and many now turn to the internet. The available data for any disease on the web is astonishing. A variety of sites can be accessed and some offer live chats or email contact with physicians who will provide information for a fee.
The question is what ability does the patient have to judge the quality of the information they are getting? When Andy Grove, co-founder of Intel Corporation http://www.phoenix5.org/articles/Fortune96Grove.html, and Michael Milken, infamous billionaire, bond trader now philanthropist http://www.mikemilken.com, were told they had prostate cancer, they each retained at considerable cost a number of experts who counseled them on the advantages and disadvantages of various treatment options. Each personally paid the experts for exhaustive studies and after lengthy discussions chose the course of action they concluded was best for them. This is a superb example of informed consent.
Another reaction to restricted access to physicians is the burgeoning of concierge medicine.
Those who choose this route sign on to a subscription program with a physician which guarantees access but does not cover the fees for care. The cost of an annual subscription can be as high as $2,500. The services provided, which are billed separately, range from consultation and advice, to direct care, to the facilitation of referrals to physicians and institutions for treatment.
Many patients realize that there can be great differences in the outcomes of treatment for many diseases and that they need help to identify the best provider, the right institution, and the best treatment option. The considerable expense attached to the method Andy Grove and Michael Milken used has led to the development of medical advocacy programs. These programs go a long way towards overcoming limited access to physicians and provide the time for a thorough discussion of these important issues.
A specific example of the role of medical advocate is the issue of physician referrals. The reason a physician chooses to refer a patient to a particular specialist can be as a result of many factors, some of which may conflict with the “best” choice. Referring physicians often select a colleague who will, in turn, refer patients to them. Some physicians are highly motivated to limit their referrals to people in their own institution and it’s rarely true that the “best” specialists are all at the same institution.
The medical advocate is a neutral party with no hidden agenda or conflicting loyalty. Objectivity is demanded in the patient-advocate relationship, uncontaminated by parochial concerns. When faced with complex, important and challenging medical decisions, patients should consider a medical advocate as a potential valuable resource. The medical ombudsman programs many hospitals have created for their patients who need support dealing with complaints and problems while in the hospital, confirms the need for a dedicated patient advocate to act as an intermediary for the patient in navigating the medical maze.