The delivery of medicine has changed dramatically over the past 50 years. While you still go to a doctor for most of your medical needs, chances are your doctor does not own his own practice. In fact, unlike 50 years ago, the majority of American physicians are employees of either hospital-owned medical practices or large group practices owned by for-profit companies.

Changing relationships

This change in ownership has had a major impact on the doctor/patient relationship. Unlike in the past, physicians and other health-care professionals are obligated to look out for the best interests of their employer and are forced to do so by their employment contracts. This easily leads to depersonalization between doctors and patients.

Studies have found that depersonalization leads to a higher likelihood of medical errors being made. The doctor simply confuses you with another patient, possibly ordering the wrong medication or being unaware of an underlying condition you may have. I recently spoke with an oncologist who sold his practice to a hospital and is required, by his contract, to see at least three patients an hour. He said he hardly gets to know his patients.

Fragmented services

My wife recently went to a large group practice for cataract surgery. There were eight doctors associated with the practice, each one having a different ophthalmic specialty (such as cataracts, dry eye, retina, post-surgical education). When my wife had a postoperative question about a pain in one eye, her cataract surgeon had her see the practice’s retina specialist. In other words, another visit, another bill, and another opinion. And by the way, the waiting room on every visit had at least 20 other patients waiting and a half-dozen clerks checking people in and out. This is the new reality of medical care delivery. The old personal touch of the doctor/patient relationship is a relic of the past. Even your primary care doctor may simply be a gatekeeper to other parts of the health system and, if she is a member of a large practice with several different office locations, she may be shuffled from office to office, forcing you to follow her around or else see another doctor in the practice.

What to do about it

Here are some steps you can take to make sure your relationship with your doctors is as personal as possible.

Come prepared. No matter how well you think your doctor may know you, come armed with your basic medical information to each visit. Not only should you bring your list of medications, but also bring a list of conditions you may have or had, surgeries you have had, and what other primary care or specialists you have seen. Bring a list of questions you may have, and make sure the doctor answers each one.

Don’t get passed off to a physician’s assistant or nurse practitioner until the doctor has explained everything in detail. The more you interact, the more personal your relationship will be.

Get second opinions. Depersonalized medicine underscores the need to seek out second opinions when a major diagnosis or treatment plan is raised. Second opinions mean another set of eyes are looking at your needs.

Monitor your medical records. You have the right to copies of your medical records, both physician and hospital. Check them out regularly to make sure all your test results, visit summaries and prescribed treatments are listed. If you see a gap or a mistake, call your practitioner to have it corrected. Remember, your medical record is the way most doctors know you. Its accuracy is vital.

Shop Around

If you feel like you are being short changed, seek out another practice. You can set up what is called an interview appointment in which you simply talk to a prospective doctor about becoming a patient in that practice. You may have to pay out of pocket for this visit, but it is worth it.

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