First posted on his blog on 01/07/2013
As I have written many times in my previous blogs, it is essential that patients and physicians partner in the management of disease. Outcomes are improved when patients are actively engaged in their own healthcare. Part of engagement involves forming a relationship with a physician through regular follow up visits. Relationships with doctors, just as with friends and spouses, evolve over time. Trust and communication skills are built through recurrent contact and interaction. Recently, a large meta analysis performed by the Cochrane group was published and concluded that routine office visits with a primary care physician had no impact on patient outcomes. Although there was an expected “buzz” in the national press concerning these findings, a closer look at the analysis demonstrates why these conclusions may not be entirely valid. As a cardiologist, I struggle to increase compliance in my patients. One of the most successful ways to improve my patient’s health and prevent cardiovascular events is through routine office visits. I can only imagine what it must be like for internists, family physicians and other primary care doctors–office visits not only allow for treatment of chronic known disorders but also provide opportunities to screen and prevent other diseases from occurring. I would argue, in contrast to the Cochrane analysis, that the routine office visit may in fact be the most cost effective therapy in medicine today.
This week, in response to the Cochrane publication, an article was published in the New York Times on the importance of primary care office visits. Author Dr. Danielle Ofri points out that each and every office encounter is an opportunity to make a difference with her patients. Often, a patient will come in with one complaint and leave having had another diagnosis made. Sometimes these diagnoses can be minor and other times diseases that could ultimately be life threatening are made. The point is, through an office interaction, patients are screened and examined. “Silent” killers such as hypertension are discovered and treatments are provided. Moreover, a relationship is built and patients and physicians can become partners and friends. Office visits create opportunity. If there are no routine opportunities then the only time that patients are seen is when disease is present and manifested. There is also a real benefit to developing a doctor-patient relationship before the patient gets sick. Difficult decisions sometimes have to be made when one is critically ill–it is nice to be able to make those decisions with someone you trust and have known for a long time rather than with a complete stranger in a white coat.
Now, more than ever, we must be good stewards of heatlhcare dollars. We must carefully decide when to test, and what treatment to use. We must avoid unnecessary testing and we must use proven therapies that have lots of evidence to back up their effectiveness. However, eliminating routine interaction between doctor and patient is NOT the way to cut costs. I would argue that this maneuver, while it may save money in the short term, will ultimately drive costs even higher. Medicine is built on relationships. A gentle touch of the hand, a smile, a nod. Like old friends meeting for coffee, an office visit is a good time to ask about family, children, and grandchildren. Many of us go into medicine because we like to interact with other people. A keen observation or a comment made as an aside may provide clues for an astute physician to ask more pointed questions and make a potential life changing diagnosis. Taking these interactions away and using pooled data derived from database dredging to minimize their impact cheapens the art of medical practice.
So, office visits are essential to providing quality care. It provides opportunity for impact. As a physician, a patient encounter is a chance to make a difference. Use each encounter to its fullest potential. Seize the Day.