Our experience as physicians, as well as years of scientific discovery, have made it clear that good health care relies heavily on collaborative relationships between patients and their clinicians. We now know that the once widely held approach, in which doctors were believed to “always know best” and as a result dictated their orders to unquestioning patients, was suboptimal medical care. In its place, healthcare is beginning to evolve toward a more patient-centered, holistic model where patients play an active role in decisions that affect their health.
Moving to this patient-centered approach also means moving away from entrenched industry dynamics and fee-for-service (FFS) payment systems that inadvertently incentivize medical practices to see large numbers of patients each day, severely limiting the time available to spend with them on time of these visits. Building trust takes time, and time is something most doctors don’t have in the traditional FFS structure. In fact, according to research, primary care physicians (PCPs) need 26.7 hours a day to fulfill all their responsibilities – an obviously impossible task and not conducive to fostering a good doctor-patient relationship.
Fortunately, new models of care are being adopted that give doctors the time they need to develop strong relationships with their patients and a doctor-patient partnership where together they determine the right type of care and treatment the patient needs and wants.
Expanding physician bandwidth with a care team
To provide effective care, it is essential to meet patients in the context of their everyday lives – knowing the communities in which they live and understanding and addressing the multiple factors affecting their health. We know that clinical care represents only 20% of health outcomes, while 80% result from social determinants of health (SDoH), including health behaviors, social and economic factors, and the physical environment. But when doctors have strict limits on their time with patients, obvious medical issues dominate these visits, and in-depth conversations that might reveal the underlying factors affecting their health rarely happen.
Taking the time to have these conversations and having the necessary resources to meet the patient’s full range of medical and social needs cannot be done by the physician alone, it requires a care team. Our experience tells us that a values-based care team approach is best, especially when it comes to senior-focused primary care. In this model, physicians are supported by a team of practitioners, including nurse educators, social workers, behavioral health specialists, and pharmacists. Using a care team can significantly reduce the number of patients each physician cares for and increase the amount of time physicians spend with each patient—in our experience, this can be up to 40 minutes per visit. This also has a positive impact on the frequency of patient visits.
In addition, through this model, the care team can provide an expanded pool of clinicians available to patients who can address the mental health issues and social service needs that become apparent when physicians have sufficient time to speak with their patients .
There’s no place like home for personalized care
While longer and more frequent interactions can open the door to understanding a patient’s day-to-day reality, there’s nothing that compares to the direct visibility you get when treating a patient in their home.
Demand for home health care quickly accelerated during the Covid-19 pandemic as patients wanted to avoid exposure to the virus in medical facilities. But even as the pandemic subsides, the benefits of receiving health care at home continue to gain momentum. In addition to the convenience and comfort that home care provides to patients, there is no better way to identify the environmental and lifestyle factors that affect a person’s health and the support systems they have in place. For example, we can see if there’s nutritious food in the fridge, check for safety hazards in their home, and contact their caregivers. It also provides a setting where open and honest dialogue can happen more naturally than in a doctor’s office. Partly as a result of the pandemic, we’ve also begun to notice that there are many conditions traditionally treated in hospitals, skilled nursing facilities, and emergency rooms that can be more effectively and comprehensively managed at home.
We view home health care as part of a patient-centered approach that allows patients to determine where they receive their care. While some people may prefer to go to a medical facility, many others would prefer and greatly benefit from receiving health care in their own home. Forward-thinking organizations are already working to make it a first-line option for patients in the long term, providing access to a wide range of services at home, including primary, emergency, emergency and hospital care.
Whether in a home setting or in a doctor’s office, developing a close, collaborative doctor-patient relationship and treating the whole patient—not just their physical symptoms—will go a long way toward improving health outcomes.
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