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Health Reform Strengthens the Doctor-Patient Relationship

Our knowledge of diseases expands exponentially each year.  New medicines and therapeutic interventions are discovered or created on a nearly daily basis.  Yet the scourge of human disease persists.  Navigating through this ever evolving maze of therapeutic options, the bond between patients and their providers remains central to the medical profession and the system in which it operates.  Some have argued that the doctor-patient relationship has deteriorated significantly in the era of big-medicine, large hospitals, and hyper-specialization.  However, a nostalgic (if not archaic) vision of how health systems should operate often resides at the core of such cynicism and serves as political fodder for those remaining adamantly opposed to the new health reform law.


Today, the House Committee on Oversight and Government Reform holds a hearing Examining the Impact of Obamacare on Doctors and Patients.  Unfortunately, the political tenor exemplified in the hearing’s very title will likely undercut what should be an honest dialogue about the core of the American health care system—the doctor-patient relationship—and the new health reform law.  The law provides a basic scaffolding to improve the accessibility, affordability, and quality of health care for all Americans and as such should provide the groundwork for moving forward together.


Many key provisions within the law have widespread public support, such as expanded insurance coverage to roughly 30 million citizens and protection of that coverage once insured.  Preventative health screenings are now covered by all plans and the Medicare “donut hole” has already begun closing.  Such provisions provide millions of Americans, previously insured or not, access to physicians and the means necessary to adhere to medical recommendations.


Two additional elements within the law stand to most positively impact the relationship between patients and providers.  First, new models of patient-centered care are being developed and implemented across the country with particular focus on coordination of interdisciplinary care for patients and assurances of its quality.  The American populace continues to age and high rates of medical comorbidities such as cardiovascular disease and obesity present increasing challenges in the management of complex patients.  Novel models such as Accountable Care Organizations and Patient-Centered-Medical-Homes allow patients to more easily navigate specialist care and empower physicians with a comprehensive stratum around which there expertise can benefit individual patients.


Another key element of the law stems from the creation of the Patient Centered Outcomes Research Institute (PCORI).  Our current, perversely incentivized system encourages higher volumes of patient visits, prescriptions, and procedures.  As we shift to a system focused on treatment outcomes, measuring and optimizing quality will be paramount. PCORI prioritizes robust comparative effectiveness research that will empower patients and providers alike with data to inform individualized therapeutic decisions around issues that matter most to patients such as quality of life, avoidance of inpatient hospitalization, and the preservation of functional vitality. These efforts finally provide doctors and patients with un-biased scientific information needed to personalize treatment alternatives focused on patient’s health—and not on cost-effectiveness, as the ACA specifically prohibits. 


While much work lies ahead in order to improve the efficiency and equity of medical care in this country, the new health reform law provides a solid foundation.  Investment in patient-centered outcomes research will ensure increasingly accurate measurement of quality while fueling the development of more innovative care models focused on individual patient needs.  Consequently, patients and providers will become closer allies in fighting disease and will do so within a health system capable of coordinating an evolving and complex medical landscape.  The doctor-patient relationship is and should remain at the heart of health care—this can be agreed upon by both ends of the political spectrum.  A profound bond of allegiance to our patients dwells at the heart of medicine and serves as common ground for the revitalization of a health system thatAmericaso very much deserves.

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