Managed Care, Doctors, and Patients: Focusing on Relationships, Not Rights

2003 ◽  
Vol 12 (3) ◽  
pp. 300-307 ◽  
Author(s):  
ROBYN S. SHAPIRO ◽  
KRISTEN A. TYM ◽  
DAN EASTWOOD ◽  
ARTHUR R. DERSE ◽  
JOHN P. KLEIN
Keyword(s):  
United States ◽  
Managed Care ◽  
The United States ◽  
Published Data ◽  
Patient Relationship ◽  
Physician Patient Relationship ◽  
Physician Relationship ◽  
Physician Patient ◽  
The Impact ◽  
Physician’S Perspective

For over a decade, managed care has profoundly altered how healthcare is delivered in the United States. There have been concerns that the patient-physician relationship may be undermined by various aspects of managed care, such as restrictions on physician choice, productivity requirements that limit the time physicians may spend with patients, and the use of compensation formulas that reward physicians for healthcare dollars not spent. We have previously published data on the effects of managed care on the physician-patient relationship from the physician's perspective. In 1999, we collected data on the impact of managed care arrangements on the physician-patient relationship from the patient's perspective. This article discusses our collective findings.

scholarly journals United States Physician Preferences Regarding Healthcare Financing Options: A Multistate Survey

Pharmacy ◽  
2018 ◽  
Vol 6 (4) ◽  
pp. 131
Author(s):  
Shamima Khan ◽  
Joshua Spooner ◽  
Harlan Spotts
Keyword(s):  
United States ◽  
Insurance Coverage ◽  
Professional Autonomy ◽  
Patient Relationship ◽  
Healthcare Financing ◽  
Physician Patient Relationship ◽  
Single Payer ◽  
Physician Patient ◽  
The Impact ◽  
System Orientation

Background: Not much is currently known about United States (US) physicians’ opinions about healthcare financing, specifically subsequent to the creation and implementation of the Affordable Care Act (ACA). Objectives: A four state survey of practicing US based physicians’ opinions about healthcare financing following ACA passage and implementation. Methods: Physician leaders practicing in the state of New York, Texas, Colorado and Mississippi were surveyed. Two factor analyses (FA) were conducted to understand the underlying constructs. Results: We determined the final response rate to be 26.7% after adjusting it for a variety of factors. Most physicians favored either a single payer system (43.8%) or individualized insurance coverage using health savings accounts (33.2%). For the single-payer system, FA revealed two underlying constructs: System orientation (how the physicians perceived the impact on the healthcare system or patients) and individual orientation (how the physicians perceived the impact on individual physicians). Subsequently, we found that physicians who were perceived neutral in their attitudes towards physician-patient relationship and patient conflict were also neutral in reference to system orientation and individual orientation. Physicians who were perceived as stronger on the physician-patient relationship were more supportive of a single-payer system. Conclusion: This study brings attention to the paradox of social responsibility (to provide quality healthcare) and professional autonomy (the potential impact of a healthcare financing structure to negatively affect income and workload). Efforts to further reform healthcare financing and delivery in the US may encounter resistance from healthcare providers (physicians, mid-level prescribers, pharmacists, or nurses) if the proposed reform interferes with their professional autonomy.

Leading up to The Myth of Mental Illness

Thomas Szasz ◽  
2019 ◽  
pp. 12-19
Author(s):  
Jan Pols
Keyword(s):  
United States ◽  
Mental Illness ◽  
The United States ◽  
Early Years ◽  
Patient Relationship ◽  
Physician Patient Relationship ◽  
The Social ◽  
Physician Patient ◽  
Psychiatric Establishment ◽  
Controversial Nature

The Myth of Mental Illness was the book that launched Szasz’s reputation as a critical psychiatrist. Although he was aware of its controversial nature, the storm it generated in the United States and beyond took him by surprise. Examining the early years of Szasz’s career and contermplating certain contextual factors, in particular the sociopolitical background that shines through his work in many ways, as well as the social circumstances around psychiatry at the time, show to what extent his publications before 1961 predicted his later rebellion against the psychiatric establishment. In these early discussions of such topics as pain, psychosomatic illness, and scientific reductionism, one sees germs of his bent toward libertarian sociological, philosophical, and ideological theories of psychoanalyis, the physician-patient relationship, sociopolitical psychology, and culture in general.

Managed Care: Effects on the Physician-Patient Relationship

2000 ◽  
Vol 9 (1) ◽  
pp. 71-81 ◽  
Author(s):  
ROBYN S. SHAPIRO ◽  
KRISTEN A. TYM ◽  
JEFFREY L. GUDMUNDSON ◽  
ARTHUR R. DERSE ◽  
JOHN P. KLEIN
Keyword(s):  
Managed Care ◽  
Healthcare Providers ◽  
Healthcare Services ◽  
Patient Relationship ◽  
Physician Patient Relationship ◽  
Delivery Of Healthcare ◽  
The Past ◽  
Important Concern ◽  
Physician Patient ◽  
The Impact

Over the past several years, healthcare has been profoundly altered by the growth of managed care. Because managed care integrates the financing and delivery of healthcare services, it dramatically alters the roles and relationships among providers, payers, and patients. While analysis of this change has focused on whether and how managed care can control costs, an increasingly important concern among healthcare providers and recipients is the impact of managed care on the physician–patient relationship. The literature includes a number of theoretical articles and anecdotal accounts of managed care's impact on the doctor–patient relationship, but little data have been collected and analyzed. We designed a survey for distribution to Wisconsin physicians to analyze the prevalence and types of managed care arrangements in the state, and the impact of these arrangements on physicians and their relationships with patients.

The Ethics of Medical AI and the Physician-Patient Relationship

2019 ◽  
Vol 29 (1) ◽  
pp. 115-121 ◽  
Author(s):  
SALLY DALTON-BROWN
Keyword(s):  
Healthcare Workers ◽  
Data Privacy ◽  
Medical Information ◽  
Ethical Issues ◽  
Patient Relationship ◽  
Physician Patient Relationship ◽  
Positive Shift ◽  
Physician Relationship ◽  
Physician Patient

Abstract:This article considers recent ethical topics relating to medical AI. After a general discussion of recent medical AI innovations, and a more analytic look at related ethical issues such as data privacy, physician dependency on poorly understood AI helpware, bias in data used to create algorithms post-GDPR, and changes to the patient–physician relationship, the article examines the issue of so-called robot doctors. Whereas the so-called democratization of healthcare due to health wearables and increased access to medical information might suggest a positive shift in the patient-physician relationship, the physician’s ‘need to care’ might be irreplaceable, and robot healthcare workers (‘robot carers’) might be seen as contributing to dehumanized healthcare practices.

Conflicts of Interest and Management in Managed Care

2000 ◽  
Vol 9 (2) ◽  
pp. 189-204 ◽  
Author(s):  
GEORGE J. AGICH ◽  
HEIDI FORSTER
Keyword(s):  
Managed Care ◽  
Conflicts Of Interest ◽  
Economic Incentives ◽  
Patient Relationship ◽  
New Paradigm ◽  
Physician Patient Relationship ◽  
Physician Autonomy ◽  
Practice Of Medicine ◽  
Physician Patient ◽  
Significant Attention

The bioethics literature on managed care has devoted significant attention to a broad range of conflicts that managed care is perceived to have introduced into the practice of medicine. In the first part of this paper we discuss three kinds of conflict of interest: conflicts of economic incentives, conflicts with patient and physician autonomy, and conflicts with the fiduciary character of the physician–patient relationship. We argue that the conflicts are either not as serious as they are often alleged to be or not unique to managed care. In part two we argue that managed care represents a new paradigm for medical care that features a new concept of management. We discuss three types or levels of management that managed care highlights, namely, administrative, clinical, and resource, which together offer a more sophisticated vantage point from which to assess patient care. We do not endorse managed care, but attempt to highlight some of the positive changes brought by managed care that were difficult to attain under traditional reimbursement systems.

The physician's disease: The impact of medical knowledge on personal illness

2007 ◽  
Vol 5 (1) ◽  
pp. 71-76 ◽  
Author(s):  
JEFFREY P. TUTTLE
Keyword(s):  
Treatment Plan ◽  
Medical Knowledge ◽  
Sick Role ◽  
Patient Relationship ◽  
Physician Patient Relationship ◽  
Consultation Room ◽  
Patients Experience ◽  
Physician Patient ◽  
The Impact

Objective: When physicians confront a personal illness of a serious nature, they may discover that the transition to the sick role is challenging, and the inability to relinquish their stethoscope may cause undo anxiety. The physician–patient relationship is intrinsically asymmetrical, and the role of the physician is to regulate the amount of information patients need in order to become educated about their illness and to make informed decisions about their treatment plan. This article explores the challenges in the physician–patient relationship when the patient is also a physician.Methods: This article is a literature review of publications involving the unique challenges physician–patients experience when suffering from serious personal illness.Results: The medical knowledge physician–patients harbor has the potential to complicate their ability to cope with difficult or terminal diagnoses. Paradoxically, knowledge about a condition may fuel anxiety instead of alleviating the fear associated with the unknown. Medical knowledge therefore may entail a certain loss of innocence, and physicians are often unable to revert to being “mere” patients. Furthermore, managing this anxiety in physician–patients may prove to be challenging to the treating physician.Significance of results: From a medical perspective, physician–patients need to be addressed like any other patient. Psychologically, however, these patients are unique, and the specific challenges their education and experience bring into the consultation room needs to be explicitly addressed.

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