Shortly thereafter, a specialist demonstrated that a primary care doctor had missed a melanoma, or had inefficiently managed a myocardial infarction, or had only three days' laparoscopy training before offering the procedure. Issues of professionalism, competence, education, and promise-keeping are raised when a referral is denied or approved with conditions. Unknown specialists 26 miles from the patient's home or office are inconvenient and often transient, as whose turn it is to be credentialed seems to change annually. Inconvenience and confusion seem certain to frustrate, discourage and anger any middle-aged patient with nephrotic syndrome who, after all, wants only to know whether he or she really needs a kidney biopsy. Pushing doctors to spend less time learning about their patients can only make for reduced doctor-patient communication, greater feelings of inadequacy and vulnerability, and a void where professionalism should be.
Physicians change behavior in response to the law, and especially in response to malpractice suits.
Harvard researcher Lucian Leape, M.D., and colleagues have documented that only 5 percent of significant inpatient errors are ever reported. Those reported are often linked to patient satisfaction and doctor-patient communication. Unfortunately for physicians, the first things to go in shortened office visits are psychosocial interactions. Physicians who want to stay employed have heard the time-crunched message. Dissatisfaction and some patient turnover are now expected, but also unnecessary.