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    Solving problem patients

    Research suggests patient encounters are deteriorating, but solutions are at hand


    But are growing regulatory hurdles, increasing workloads and transparency, declining reimbursements, and more making the problem worse? It could be, said Eugene Rhee, MD, MBA, regional coordinating chief of urology for the Southern California Permanente Medical Group and national chair of urology for Kaiser Permanente.

    Read - Survey: Urologists weigh in on MIPS, APMs, burnout

    Eugene Rhee, MD, MBADr. Rhee“There are questions arising as to the difficulties of patient encounters and whether or not this is due to ‘problem patients’ or an eroding physician-patient relationship,” Dr. Rhee said. “In my opinion, the challenges arise from a variety of factors—some societal and some institutional.

    “There is no doubt the patient in today’s society literally has the ability to extract any information from a question both in speed and context. This well-informed patient now is equipped with a more fundamental understanding of their clinical problem before ever setting foot in the urologist’s office. This inherently requires more time and attention to the encounter.”

    Dr. Rhee points to the Urology Times State of the Specialty survey, which also suggests regulatory pressures, increased overhead, and lower reimbursements institutionally for U.S. urologists are directly impacting the core of the quality of the patient encounter. He also cites AUA census data that show rising numbers of patients each year and an increase in the number of employed urologists to more than half of U.S. urologists practicing today. The resulting “perception” of loss of control and autonomy, based on surveys, may point to pressures on the urologist-patient encounter, according to Dr. Rhee.

    Michael Navratil, a medical malpractice defense attorney with John Cotton and Associates in Las Vegas, says that while he hasn’t seen a rise in medical malpractice claims in recent years, he has noticed increasing patient hostility toward providers. They’re expressing frustration with wait times, insurance, the sometimes-difficult process of seeing doctors, quick in-and-out visits, and a lack of connection with their doctors, he says.

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    “Those are things I hear both from patients when I depose them during the cases and also from jurors—the jurors that are deciding the med-malpractice cases are feeling the same frustration,” Navratil said.

    Next: Who is the difficult patient?

    Lisette Hilton
    Lisette Hilton, president of Words Come Alive, has written about health care, the science and business of medicine, fitness and wellness ...


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