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Crumbling Boundaries Between Patients and Doctors

Crumbling Boundaries Between Patients and Doctors

Physicians manage multiple conflicting domains: diagnosing and treating disease, complying with payer rules, and using what's been called cumbersome EHR technology, to name a few. While that may not be anything new for agile, multi-tasking physicians, it leaves little time to connect with patients. And connecting with patients has taken on new urgency as physicians are now judged on their ability to make patients happy, via satisfaction surveys like the Consumer Assessment of Healthcare Providers and Systems (CAHPS). But as any experienced physician knows, relaxing the professional boundaries that are so necessary to establishing an effective provider-patient relationship can be problematic.

Barbara Malat, a retired, certified physician assistant (PA), who practiced family medicine for 22 years, most recently in Rochester, Minn., says it is becoming harder to maintain patient boundaries for many reasons. Due to a prevalence of direct-to-consumer pharmaceutical ads on TV and homeopathic cures touted on social media and the web, many patients are becoming anxious, fearful, and demanding. "I actually had one young woman call me and say, 'I'm really anxious when I go to parties and I don't know anyone. I think I have social phobia. I saw that commercial on TV and I'm sure that is the medication that I need,'" says Malat.

If you find yourself experiencing similar pressures and wonder how you should respond to increasing patient demands for specific treatments that they may not need, in order to maintain their good will, here's what other physicians and consultants are saying.

Strained Relationships

Many patients nowadays seem to have an expectation of instant access to medical care. However, they are busy, too, and many cannot take an afternoon off to see the doctor for fear they will be laid off or receive a short paycheck. Unfortunately, this can place undue pressure on physicians to succumb to patient demands. Malat, who was also past president of the Association of Family Practice Physician Assistants, says she has experienced this scenario many times.

"Not uncommonly, patients would come in and say, 'I'm here and I need to be treated because I have to get back to work tomorrow.' … There were a series of those kinds of things, because someone didn't have good benefits or their employer said, 'You have to be back [in] two days or this is it for you,'" Malat says.

That lack of time may also push patients to ask the physician for a prescription over the phone for a malady they have self-diagnosed, like a suspected sinus infection. Malat says when she had established trust and a good working relationship with her patients, they were often more open to listening to her diagnosis and suggested treatment plan, even if that meant trying a course of over-the-counter medication first.


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