'There can be no secrets between us'

  | May 26, 2017

Healthcare has always been about the relationship between physician and patient — and that relationship needs to be a partnership. As the CEO of a physician-led, clinically integrated care network, I've learned that for each aspect of care, there is a physician responsibility and a corresponding patient responsibility.

Patients, in the end, are responsible for their health and their health-seeking behavior. Physicians are their trusted advisors. Both share a joint responsibility for the journey.

And both benefit from shared guidelines — some explicit, some unspoken — that make the partnership work.

Guideline one: Trust and transparency

The patient's first job is to choose a provider with whom she can have a mature, honest relationship with joint collaborative responsibility for outcomes. The consequences of not having that relationship with an individual physician or a care team fall squarely on the shoulders of the patient.

I tell my patients, “I'm going to be honest with you. I will show empathy, but I will always tell you the truth." I must be transparent with them — anything I document in their medical records, they will have access to — and they must do their part by reviewing those records and asking questions. There can be no secrets between us.

Guideline two: Honest financial discussions

I must ask patients about their financial situation: What can they afford, what can they not afford? And any time I make a recommendation for a procedure, a test, or an appointment with another provider, they should immediately ask me, “What is the cost? Are there alternatives?"

This doesn't mean I'm making decisions based on cost. I am making recommendations based on treatment options, then having frank conversations about the financial consequences of those options. It is then the patients' responsibility to determine the best option for them. I believe that today, a physician who does not understand the economic consequences of his or her recommendations is practicing unethical medicine.

Guideline three: Mutually-agreed-upon health goals

I need to understand where patients want to be with their health, what they are willing to do, and what they are not to get healthier. I can advise them, but I can't make them do anything.

If you are a diabetes patient with an HbA1c level of 12, I might suggest a goal of 8. Then we'll talk through why that outcome is important, and what it would require for you to get there. But you might say, “What you are asking me to do is not something I'm willing to do because I'd have to give up A, B, and C."

Very well. I'll take the next step and ask you: If you're not able to do your part to achieve this goal, what are you willing to do? The patient and the physician together must negotiate a shared goal that the patient is willing to work on.

Guideline four: Support for the work

Patients need to have a basic understanding of the tests and actions in their care plans, and they need to commit to following those plans. But helping patients follow through on that work — and it is work — is the job of the care team.

Patients have busy lives. Technology should automate the alerts, the reminders, and the scheduling. But it's not good enough to say, “I sent you a reminder, you didn't respond, and now look what's happened a year later." When a patient doesn't show up for an appointment or respond to a request, the physician and the care team should personally reach out to say, “What's happened in your life? How can I help you do what you need to be successful?"

The patient must set the goals, and we must deliver services that meets their unique, contextual needs. Patients make complex decisions all day, every day, related to their families, their jobs, their financial situations, their relationships.

They can make those same complex decisions around healthcare. As physicians, it's our job to help them do it. These guidelines can help make the physician-patient relationship a true partnership in achieving the best possible health outcomes.

David Hanekom, M.D., is CEO of Arizona Care Network ACO.

'There can be no secrets between us'