*Impact Paper Directions* Write a 2 to 3 page paper concerning the impact the de
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*Impact Paper Directions*Write a 2 to 3 page paper concerning the impact the development of MCOs has had on the doctor-patient relationship.
List issues that have impacted the doctor-patient relationship due to the development of MCOs and the change in what the MCO expects from a doctor. After listing the issues, discuss the positives and/or negatives of each. From your text readings and research through the virtual library, etc., do you believe that the doctor-patient relationship has been affected more positively or negatively? Cite references to back your writings.
*Impact Paper Directions*
Write a 2 to 3 page paper concerning the impact the development of MCOs has had on the doctor-patient relationship.
List issues that have impacted the doctor-patient relationship due to the development of MCOs and the change in what the MCO expects from a doctor. After listing the issues, discuss the positives and/or negatives of each. From your text readings and research through the virtual library, etc., do you believe that the doctor-patient relationship has been affected more positively or negatively? Cite references to back your writings.
*Impact Paper Directions*
Write a 2 to 3 page paper concerning the impact the development of MCOs has had on the doctor-patient relationship.
List issues that have impacted the doctor-patient relationship due to the development of MCOs and the change in what the MCO expects from a doctor. After listing the issues, discuss the positives and/or negatives of each. From your text readings and research through the virtual library, etc., do you believe that the doctor-patient relationship has been affected more positively or negatively? Cite references to back your writings.
Explanation / Answer
The development of MCOs has had a great impact on doctor-patient relationships. The physician-patient relationship is still a fiduciary relationship. The physician still treats patients one at a time as unique and valued individuals. The physician is expected to be a prudent steward wisely judging the limits of care. To be effective patient advocates, doctors must help patients balance medical benefits and financial risk.5Trust, caring and honesty are at the foundation of the physician-patient relationship. Traditional medical ethics, as embodied in the American Medical Association's Code of Medical Ethics, has served as an ethical guide since the mid-1840s and has focused on physicians' responsibility to individual patients. But the code fails to address other physician obligations adequately, such as providing universal access to health care and preventive services.
A survey submitted by Susan Dorr Goold, MD, MHSA, MA and Mack Lipkin, Jr., MD, 1999 on physician-patient relationship and the development of MCO research stated that “Managed care frequently puts physicians in an adversarial position with their patients”.( PMCID: PMC1496871). Physicians feel that the amount of time they need to explain and discuss issues with families relating to coordinating referral appointments and insurance takes up more of their time with them each year. The survey also showed the some physicians feel that managed care organizations creates an incentive not to care for sick complicated patients and will cause the quality of care to suffer as escalating office overhead coupled with low capitation rates translates into the economic necessity to see more patients.
Some issues list in the survey that have impacted the doctor-patient relationship due to the development of MCOs and the change in what the MCO expects from a doctor included: The Physicians’ obligation to put their patients first. Most primary care physicians in the survey group believe that managed care diminishes the ability of the physician to place the patient's interest first and to avoid conflicts of interest between patients and physicians' financial incentives. Forty-nine percent indicated negative effects on their abilities to respect patients' autonomy. These findings, coupled with the concerns expressed by respondents that under managed care cost cutting takes priority over quality of patient care, indicate that managed care results in troubling conflicts of interest for physicians, and that patient care may be compromised under these systems. In fact, in the open comments, the survey respondents were often passionate about the conflicts of interest and decreased services to patients. Since only 15% of the total survey group responded with such negative open comments, we do not know if those strong views represent a vocal minority or are more widely shared.
Most of the physicians who took the survey identified the decreased patient choice in medical decisions as having a negative impact on the physician-patient relationship, which could adversely affect care as well. Some physicians also identified limitations in choice of specialist and the frequency of specialist visits, in sites of diagnostic testing and procedures, and in length of hospital stay as having a negative impact on the overall quality of patient care. Limiting options for care is one of the main methods that managed care systems use to control health care utilization. While limiting options is not necessarily bad for the quality of patient care, most physicians responding to our survey believe that at least some limitations in health care are detrimental.
Physicians also stated that they believed that managed care frequently provides better preventive services, and the largest group believed that managed care frequently decreases expense. Physicians in other survey studies have expressed similar opinions about cost cutting and preventive care. While physicians' attitudes on quality of care do not substitute for more objective evidence, they identify areas for further investigation when designing quality evaluations
According to the survey, one third of responding physicians indicated that they are less able to respect patient confidentiality under managed care. Although managed care often uses quality assurance techniques such as individual patient chart reviews and computerized data banks for utilization and quality reviews, many physicians may not view this access to patient information as a meaningful violation of patient confidentiality.
The continuity of the physician-patient relationship is a central obligation for practitioners of clinical medicine. More than half of the respondents believe that continuity of the primary care physician–patient relationship has been negatively affected by managed care. Changes in managed care plans offered by employers, and insurance changes due to job changes, have affected continuity of care. In a recent survey physicians self-reported that they had lost an average of 9% of their patients due to insurance plan changes. A 2-year longitudinal study using patient questionnaires found continuity to be higher in fee-for-service systems than in prepaid health care systems.
Positive physician-patient relationships are essential for effective medical care. About two thirds of survey respondents indicated that managed care has a negative impact on physician-patient relationships. Respondents' choices on other survey questions may indicate some of the likely causes.
Some physicians also indicated that they have less time for their patients because of emphasis on increased productivity under managed care. Any health care reform that is aimed at reducing costs is likely to result in productivity pressures. Physicians, to maintain their incomes, may be seeing more patients. If the perceptions of this physician group are accurate, many patients may have diminished roles in making medical decisions under managed care, since patients' levels of participation in decision making is related to length of office visits and duration of their relationships with physicians. In a separate question, most respondents indicated that managed care had adverse affects on patient choice in medical decision making.
In conclusion, most of the responding physicians noted that patients perceive them as adversaries because of their gatekeeper roles. At its best gatekeeping can be a positive activity, in which physicians use their knowledge of the medical system to shepherd patients through most effectively and protect patients from overtreatment and unnecessary tests. Gatekeeping becomes problematic if financial incentives are linked to restricting medical care. Providers may underuse appropriate services and treatments. A Boston-area survey examined the attitudes of physicians who served both as primary care gatekeepers for a managed care health plan and as providers for patients with traditional indemnity insurance, and found that many believed gatekeeping had negative effects on the physician-patient relationship, freedom in clinical decisions, time spent with patients, and ease of ordering expensive tests or procedures
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