The 21st Century Patient-Physician Relationship

Published: Thursday, Feb 21, 2008
You can probably sympathize with the worry and anxiety your colleagues felt following the invention and rapid adoption of the telephone in the late 1800s. For them, this new device sparked concern and debate, raising new questions regarding their duties to their patients. Would the easy access promised by phone service prompt patients to make increased demands on physicians’ time? If so, what obligations did physicians owe to patients calling at all hours of the night? Was it ethical to conduct a medical consultation over the phone? Would answering the phone and briefl y talking with a patient necessarily establish a relationship, making the physicians duty bound to provide continuing care? Would resorting to telephone-based communication depersonalize the historical personal bond between physicians and their patients?

Today, physicians and patients are wrestling with the changes wrought by new, more powerful technologies and are seeking answers to many of the same kinds of questions regarding the physician– patient relationship that confronted their 19th century forebears. Communication between physicians and patients nowadays is near instantaneous and can be conducted in a bewildering variety of formats: telephone, fax, e-mail, voicemail, video conferencing, and instant messaging. Patients grown accustomed to 24/7 customer service in their other personal and business transactions (especially those conducted online) are increasingly demanding the same level of access to and responsiveness from their healthcare providers. Physicians are struggling to keep up with the demand, but must weigh their desires to be available to their patients against questions regarding reimbursement for time spent, privacy issues, and liability concerns.

Patients are also demanding more convenience and flexibility from physician practices when it comes to setting up appointments, requesting medication refills, obtaining test results, and other services. In the past, patients had to rely solely on the discretion and timetable of their healthcare providers, but now, thanks to the availability of practice websites featuring applications that enable online appointment scheduling and prescription refill ordering, patients are growing accustomed to on-demand service from healthcare providers.

You Have Mail, But Not From Your Patients

So what gives? Drop us a line at ccole@mdng.com and share your opinions on physician–patient e-mail communication.

But perhaps the most profound change to the patient–physician relationship has come about due to patients’ ability to quickly access healthcare information. In the past, patients who desired to read clinical medical information required access to a medical library. Even then, the process of uncovering relevant data was laborious, time consuming, and isolated. The only interactive part of the process involved asking a librarian how to use the microfische. Nowadays the Internet enables rapid access to even the most obscure clinical journals, not to mention dozens of user-friendly sites that distill and interpret that information, leading to the advent of new terms to describe patients and their attitudes and roles vis-à-vis healthcare delivery: “informed,” “active participant,” “empowered.”

And thus, the patient–physician relationship continues to evolve, with technology playing an ever-greater role in driving the changes. From how patients and providers communicate between office visits to how patients interact with their providers during an exam, from the services patients expect from practices to the ways in which patients search for, internalize, and act on medical information, healthcare information technology is altering the physician–patient relationship in ways great and small.

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