What Patients Want

In the movie “What Women Want,” Mel Gibson’s character Nick is transformed by being able to hear women’s thoughts. What if we could hear our patients’ thoughts? As they sit in the waiting room, talk with the staff, look around the office, listen to us, and depart, our patients are undoubtedly sizing us up: Is this the physician I want to entrust with my health? How might we change if we really knew what patients want?

Managed care and patient values

Managed care has done much to teach us what patients do not want. The principles of managed care are fine—appropriate care delivered with consistent standards. The trappings of managed care tend to violate core patient values, such as the ability to choose physicians and being able to trust their physicians’ decisions. Patients have rebelled, as insurance plans have directed them to certain primary care providers and require that the physician’s decisions be approved by a higher authority.

The 2 articles in this issue from The Health Institute in Boston validate the core elements of the physician-patient relationship and show that these elements have eroded in the past few years.^1,2 No matter how much administrators try to define and dissect medicine into units of service (relative value units), patient care is fundamentally based on human interaction. Diseases do not come for treatment, people do. Although industrialized health care systems think management, people want healing. Healing requires healing relationships.

Giving patients what they want

So what are we to do with these data showing that the relationship elements of care—trust, interpersonal treatment, knowledge of the patient, and communication—are what patients want and that these elements have been eroded in recent years? Health care is a service industry consuming more a trillion US dollars every year. Ultimately, those who succeed will do so by giving patients what they want. Family physicians should be satisfied by these validating studies and realize that the core relationship elements of care are critical for their success. Gatekeeping brought us back to the frontline of care in the early 1990s, but that is not what patients want. Being true personal physicians is what sustains us in the long run. Today’s health systems must relearn this. When we entered medicine years ago, we were taught some timeless adages that are validated by this research and need to be continually reaffirmed:

• Patients want the 3 “As”—accessibility, affability, and ability, in that order.
• Patients do not care how much you know until they know how much you care.
• It is much more important to know what sort of patient has a disease than what sort of disease a patient has.³
• The secret of caring for the patient is caring for the patient.⁴

How do we operationalize these principles in the 21st century? Will the new information and communication technologies be used to make care more personal or impersonal? We can use electronic communication to enhance our relationships with patients by making us directly available and continuously accessible to them. As for managed care and the problems causing the negative findings in these studies, everyone involved with health care payment and administration must realize that continuous relationships based on trust are critical for effective care. Now is the time to develop new structural features in our practices to give patients what they want.

In the movie “What Women Want,” Mel Gibson’s character Nick is transformed by being able to hear women’s thoughts. What if we could hear our patients’ thoughts? As they sit in the waiting room, talk with the staff, look around the office, listen to us, and depart, our patients are undoubtedly sizing us up: Is this the physician I want to entrust with my health? How might we change if we really knew what patients want?

Managed care and patient values

Managed care has done much to teach us what patients do not want. The principles of managed care are fine—appropriate care delivered with consistent standards. The trappings of managed care tend to violate core patient values, such as the ability to choose physicians and being able to trust their physicians’ decisions. Patients have rebelled, as insurance plans have directed them to certain primary care providers and require that the physician’s decisions be approved by a higher authority.

The 2 articles in this issue from The Health Institute in Boston validate the core elements of the physician-patient relationship and show that these elements have eroded in the past few years.^1,2 No matter how much administrators try to define and dissect medicine into units of service (relative value units), patient care is fundamentally based on human interaction. Diseases do not come for treatment, people do. Although industrialized health care systems think management, people want healing. Healing requires healing relationships.

Giving patients what they want

So what are we to do with these data showing that the relationship elements of care—trust, interpersonal treatment, knowledge of the patient, and communication—are what patients want and that these elements have been eroded in recent years? Health care is a service industry consuming more a trillion US dollars every year. Ultimately, those who succeed will do so by giving patients what they want. Family physicians should be satisfied by these validating studies and realize that the core relationship elements of care are critical for their success. Gatekeeping brought us back to the frontline of care in the early 1990s, but that is not what patients want. Being true personal physicians is what sustains us in the long run. Today’s health systems must relearn this. When we entered medicine years ago, we were taught some timeless adages that are validated by this research and need to be continually reaffirmed:

• Patients want the 3 “As”—accessibility, affability, and ability, in that order.
• Patients do not care how much you know until they know how much you care.
• It is much more important to know what sort of patient has a disease than what sort of disease a patient has.³
• The secret of caring for the patient is caring for the patient.⁴

How do we operationalize these principles in the 21st century? Will the new information and communication technologies be used to make care more personal or impersonal? We can use electronic communication to enhance our relationships with patients by making us directly available and continuously accessible to them. As for managed care and the problems causing the negative findings in these studies, everyone involved with health care payment and administration must realize that continuous relationships based on trust are critical for effective care. Now is the time to develop new structural features in our practices to give patients what they want.

In the movie “What Women Want,” Mel Gibson’s character Nick is transformed by being able to hear women’s thoughts. What if we could hear our patients’ thoughts? As they sit in the waiting room, talk with the staff, look around the office, listen to us, and depart, our patients are undoubtedly sizing us up: Is this the physician I want to entrust with my health? How might we change if we really knew what patients want?

Managed care and patient values

Managed care has done much to teach us what patients do not want. The principles of managed care are fine—appropriate care delivered with consistent standards. The trappings of managed care tend to violate core patient values, such as the ability to choose physicians and being able to trust their physicians’ decisions. Patients have rebelled, as insurance plans have directed them to certain primary care providers and require that the physician’s decisions be approved by a higher authority.

The 2 articles in this issue from The Health Institute in Boston validate the core elements of the physician-patient relationship and show that these elements have eroded in the past few years.^1,2 No matter how much administrators try to define and dissect medicine into units of service (relative value units), patient care is fundamentally based on human interaction. Diseases do not come for treatment, people do. Although industrialized health care systems think management, people want healing. Healing requires healing relationships.

Giving patients what they want

So what are we to do with these data showing that the relationship elements of care—trust, interpersonal treatment, knowledge of the patient, and communication—are what patients want and that these elements have been eroded in recent years? Health care is a service industry consuming more a trillion US dollars every year. Ultimately, those who succeed will do so by giving patients what they want. Family physicians should be satisfied by these validating studies and realize that the core relationship elements of care are critical for their success. Gatekeeping brought us back to the frontline of care in the early 1990s, but that is not what patients want. Being true personal physicians is what sustains us in the long run. Today’s health systems must relearn this. When we entered medicine years ago, we were taught some timeless adages that are validated by this research and need to be continually reaffirmed:

• Patients want the 3 “As”—accessibility, affability, and ability, in that order.
• Patients do not care how much you know until they know how much you care.
• It is much more important to know what sort of patient has a disease than what sort of disease a patient has.³
• The secret of caring for the patient is caring for the patient.⁴

How do we operationalize these principles in the 21st century? Will the new information and communication technologies be used to make care more personal or impersonal? We can use electronic communication to enhance our relationships with patients by making us directly available and continuously accessible to them. As for managed care and the problems causing the negative findings in these studies, everyone involved with health care payment and administration must realize that continuous relationships based on trust are critical for effective care. Now is the time to develop new structural features in our practices to give patients what they want.