Whose Patients?

Recently, I was talking to one of my colleagues from the University of Elsewhere on the phone. When we had resolved the issue that led to our phone call, our discussion touched informally on some topics of mutual interest such as waiting times for our outpatient clinics. I have to preface what follows by stating that my colleague is a middle aged male, well respected as a physician and academic in his field, a man of sound and balanced judgment, and definitely not a self-righteous man. I was therefore surprised hearing him proudly say “my patients prefer waiting to see me over seeing one of my colleagues [in the same program at the University of Elsewhere] at an earlier time point”.

I am not sure he meant to indicate that he was the superior provider than his colleagues. However, in our ensuing discussion I definitely got the impression that he sincerely felt that patients referred to him as an individual provider were “owned” by him, and not “just” individuals who seek medical services provided by his group or program.

Taking ownership of the issue(s) of patients and working engaged to resolve them is a good thing. I am, however, not sure whether or how my colleague’s literal interpretation of “ownership” is in the best interest of patients. Nevertheless, the attitude that patients belong to an individual provider seems to remain surprisingly wide spread in these times. The many reasons for this may include the fact that most individual physicians in our institutions are appointed to provide a service at, but are not employed by that institution – which tends to further a single fighter or solo practitioner mentality. I wonder if some male chauvinism my also play a role, as this attitude seems to me anecdotally more prevalent among men than women.

In any case, the attitude of patients belonging to a provider usually fails to optimally serve the patient and is definitely not compatible with equal access.  A patient wants to receive, in a timely manner, expert care for a specific medical issue by a professional qualified to provide that care. One would think that every faculty member of a given program is capable of providing the basic services the program is supposed to provide. If not, this needs to be remedied. If so, most patients would want to have access to the service as timely as possible, i.e. see the next available provider in the next available clinic time slot.

In order to accommodate this patient wish, a central review of all referrals with a transparent system of triaging according to urgency is required. I encourage our academic and program leadership  in the various programs in our Department to discuss such systems within their sections and to develop and implement such a system, or if there is already one in place, to periodically audit, review, and adapt it, if necessary.


4 thoughts on “Whose Patients?”

  1. I wish it were so but clearly there are major differences in physicians with the same qualifications. This is for various reasons but most commonly the physician’s approach to patient care and not his/her ability. The type of system you are suggesting is just one more step in removing any continuity from patient care. Exactly the same desired outcome could be achieved by posting the current waiting time for each consultant and letting the referring MD decide in consultation with their patient.

    1. I agree with Dr. Renner. Moving forward, patients should consider themselves associated with teams and systems, not simply personnel. Quality of care should be judged by performance and outcomes data, including patient experience not solely by referring provider’s opinions.

  2. This would require a paradigm shift from the way things have been done. Definitely should decrease the wait times and move towards a bit less variation in care.

  3. in Geriatrics our patients belong with a service rather than an individual provider. it maximizes efficiency, but we have not surveyed patients and families or referring providers whether they would prefer to wait longer to always see the same provider. This system does require a similarity of approach and a high degree of trust among all the providers. This may be easier in our small section than in a larger one. Our practice of meeting weekly for academic rounds may help as we can discuss clinical issues frequently.

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