Time and Place Are of the Essence: Constructing Relationships With Sufferers for Higher Well being Outcomes


Our experience as physicians, as well as years of research findings, have made it clear that good healthcare relies heavily on the collaborative relationship between patients and their clinicians. We now know that the once widely accepted approach in which physicians were believed to “always know best” and as a result dictated their orders to unquestioning patients is suboptimal medical care. In its place, healthcare is beginning to evolve to a more patient-centered, holistic model, where patients play an active role in the decisions that involve their health.

Moving toward this patient-centered approach also means moving away from the entrenched industry dynamics and fee for service (FFS) payment system that inadvertently incentivize medical practices to  see large numbers of patients each day, severely limiting the time available to spend with them during those visits. Building trusting relationships takes time, and time is something most physicians do not have under 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 good physician-patient relationships.

Fortunately, new models of care are being adopted that allow physicians the time needed to develop strong bonds with their patients and a physician-patient partnership where, together, they determine the right type of care and treatments the patient needs and wants.

Expanding physician bandwidth with a care team 

To provide effective care, it’s essential to meet patients in the context of their daily lives – knowing the communities in which they live and understanding and addressing the multiple factors impacting their health. We know that clinical care accounts for only 20% of health outcomes, while 80% are the result of social determinants of health (SDoH), including health behaviors, social and economic factors and physical environment. But when physicians have strict limits on their time with patients, obvious medical concerns dominate those visits, and the in-depth conversations that can reveal the underlying factors impacting their health rarely occur.

Making the time for those conversations and having the resources necessary to address the patient’s full range of medical and social needs can’t be done by the physician alone, it requires a care team.  Our experience tells us that a value-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 care coaches, social workers, behavioral health specialists and pharmacists. Utilizing a care team can substantially reduced the number of patients each physician cares for and increased the time physicians spend with each patient — in our experience, that can be as much as 40 minutes a visit. This, also has a positive impact on the frequency of patient visits.

Additionally, through this model the care team can provide an expanded group of clinicians available to patients who can address the mental health issues and social service needs that become apparent when physicians have substantive time to talk 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 everyday reality, there’s nothing that can match the direct visibility you get when you treat a patient in their home.

The demand for in-home healthcare quickly accelerated during the Covid-19 pandemic, because  patients wanted to avoid exposure to the virus in medical facilities. But even as the pandemic subsides, the benefits of receiving healthcare in the home continue to gain traction. In addition to the convenience and comfort care in the home  provides patients, there is no better way to identify the environmental and lifestyle factors impacting a  person’s health, as well as the support systems available to them. For example, we can see if there is nutritious food in the fridge, check safety hazards in their home and connect with their caregivers. It also provides a setting where an open and honest dialogue may occur more naturally than in a doctor’s office. Partly as a result of the pandemic we have also begun to take notice that there are many conditions traditionally treated in hospitals, skilled nursing facilities and emergency departments that can be more effectively and holistically managed in the home.

We view in-home healthcare as part of a patient-centered approach that allows patients to determine where they receive their care. While some people may prefer to make a trip to a medical facility, many others would prefer and greatly benefit from receiving healthcare in their home. Forward thinking organizations are already working to make it a first-line option for patients for the long term, providing access to a wide range of at-home services including primary, emergency, urgent and hospital-level care.

Whether in the home setting or a doctor’s office, developing a close, collaborative physician-patient relationship and treating the whole patient – not just their physical symptoms – will go a long way towards improving health outcomes.

Photo: kieferpix, Getty Images



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