How to rebuild trust in our healthcare system

Felice J. Freyer’s May 8 article in the Boston Globe calls out that Americans’ trust in medicine is declining but that doctors can still turn it around. The piece focuses our attention on an often-overlooked critical issue - trust. To quote Dr. Andrew W. Bazemore (senior vice president of research and policy for the American Board of Family Medicine): “[Trust] is one of the most powerful tools of medicine, and if you don’t have it, no number of drugs, devices or other interventions are going to achieve much.”

So the decline in trust in healthcare is a major issue. In fact, I would go so far as to say that healthcare has lost its soul because trust is not a routine part of healthcare today. The article goes on to describe how TRUST is developed with patients. Dr. Katherine Gergen Barnett offers this description: “Trust is built in the context of human relationships…it is fostered by asking open-ended questions, staying curious about reasons behind the patient’s beliefs, and recognizing that a patient knows their body better than anyone else.”

So why isn’t trust a part of healthcare today? The reason is that healthcare’s billing and coding system cannot measure obtaining or seeking a patient's trust. If the insurer cannot measure something, they will not pay for it. It is hard to measure conversations. Doctors in today's intense world cannot afford to spend significant time on an activity that is not compensated. And by the way - building trust takes real time. I would go so far as to say that healthcare’s billing and coding system does not pay physicians to have conversations with patients - that is why patient visits have to be short. Just as bad is the fact that the billing and coding system does not pay physicians to talk to each other. Referrals today are simply a note in the chart. Referrals used to mean a physician personally discussing their patient to give context for the referral. That effort requires unpaid time for both physicians. One of the biggest problems in healthcare today is fragmented care - no one coordinates care. Why? Because coordination is very time-consuming and depends on conversation.

Until we change how we pay primary care physicians so they have time to build trust with patients and they have time to coordinate patient care, trust in medicine will continue to decline. Now there are physicians - a declining breed -- who do all these things without compensation but they are poorly paid and overworked. Physicians deserve to be paid for building trust with their patients. It would dramatically improve the quality of care and it would lower costs. To learn how to do it, go to www.thejourneys-end.org.

How we can help healthcare regain its soul

It was my honor to give a presentation titled "The US Healthcare System: Can We Do Better?" this month at The Bur Oak Foundation, an independent, non-partisan, non-profit educational foundation dedicated to serving the academic community of the University of Michigan. I thank my hosts for the opportunity to present on a topic that means so much to me personally, the fact that healthcare today has lost its soul - its sense of humanity. The nature of healthcare has become transactional and impersonal. As a result, the current state of U.S. healthcare is dire. Costs are astronomical and patient outcome and satisfaction are low. Healthcare has become transactional by emphasizing coding, procedures and tests over relationships and conversations. To fix healthcare, we need to start with simplicity, incentives and culture. We can do that by prioritizing primary care, reforming end-of-life care and limiting insurance interference with clinical decision making while making long-term investments in nutrition and education. To watch the presentation, scroll to the bottom of this page or access it directly here on YouTube.

Lack of investment in primary care decline hurts us all

The Milbank Memorial Fund is a wealth of information on US primary care. In particular, they have completed numerous studies on the importance and value of primary care. In addition, each year for the last several years, Milbank has issued a national scorecard on the state of primary care in the US. Unfortunately, these scorecards document a steady decline in primary care investment at a time when those resources have never been more important.

This quote from the report summarizes the issue:

”This combination of worsening primary care access and sicker patients has created a vicious cycle. Patients are driven to use more expensive services like emergency rooms, which raise healthcare costs and premiums, further reducing affordability and access. At the same time, overall healthcare spending continues to rise faster than economic indicators, while the crumbling primary care infrastructure receives only a small portion of these dollars.”

To be more specific, in 2022 US healthcare spending on primary care was under 5%. Other countries with advanced health systems and much better health outcomes spend on average 14% of health expenditures on primary care. Even more depressing is the fact Medicare only spends 3.4% of its funds on primary care.

Hopefully, the new administration will embrace these common sense facts and focus on improving primary care. Several options for that investment are possible. Go to www.thejourneys-end.org for more details.