Last week I attended an intensive course in Primary Care Medicine sponsored by Harvard Medical School. Lectures were given in the morning with small breakout sessions in the afternoon. I would like to share some observations I made while participating in one of the breakout sessions.  

Over 70 studies have shown that motivational interviewing about lifestyle behaviors significantly improves patient outcomes. Motivational interviewing is a fancy term for questions and answers aimed at increasing the patient's motivation to change. The most significant changes made involved weight loss, exercise, smoking, safe sex practices, seat belts use, monitoring blood pressure and blood sugar, when appropriate, and coping with emotions. Sadly, this session was the least attended. The most popular sessions dealt with how to best diagnosis and treat specific medical problems. I was curious as to why the motivational interviewing session was the least popular, so I asked other physicians. I was fascinated by their answers. The consensus was that they saw the value of teaching and coaching patients to change their behaviors, but not practical in today’s medical model. I heard comments such as ‘I cannot do this in the machine gun pace of outpatient medicine today,’ or ‘I have too many patients to see in the course of a day to spend the time to do what is suggested.’ Here in lies the answer as to why the healthcare system is in the state that it is, and generally speaking, why many so patients are dissatisfied with their medical care.

You may be interested to know that the average health insurance company spends approximately 90% of its reimbursement to physicians for the diagnosis and treatment of disease, and about 10% of its budget on preventive medicine. To me, this is the wrong way reimbursement should be allocated, and in fact the percentages should be reversed. If we are to be good motivators for our patients, and help them take responsibility for making appropriate lifestyle changes that will increase the quality of their life, and very significantly reduce their healthcare expenses, we must spend more time with them.

I feel the government and private insurance companies should reimburse primary care physicians to talk to patients and teach good health practices. America spends a greater percentage of our Gross National Product on healthcare than any other country in the world. In fact, no other country even comes close. Despite these huge expenditures for healthcare, the longevity for adults is lower and infant mortality is higher than in many other countries. You may ask why this dichotomy exists? The reason is quite simple; we spend very little for the prevention of disease and a great deal of money for the diagnosis and treatment of disease. There is no question that the USA is the best country in the world for health care in terms of making a diagnosis and treating it, but not for preventing disease. This concept reminds me of the Fram Oil Filter advertisement that says ‘pay me now or pay me later.’ Preventing any disease is far less expensive than treating it.  I don’t know any physician who wouldn’t like to spend more time with his or her patients, but unfortunately the constraints placed upon physicians as dictated by insurance companies and needless government regulations do not allow for this to happen.

Physicians are no longer in control of their destiny. Poor government legislation, insurance companies, and employers of physicians determine their destiny. It appears that the privately owned medical practice is going away like the horse and buggy.  When physicians owned their own practice they could determine how they practiced medicine, and how many patients they would see per day. Today, that determination is made by the physician’s employer who has the responsibility to produce profit, not quality medicine.  Remember, most insurance companies are publicly traded corporations whose goal is to return profits to its shareholders.  

One way to help educate patients is to employ the services of Nurse Practitioners. Nurse Practitioners are nurses first, with nurturing personalities.  A kind, caring, and nurturing personality is necessary for interacting with patients regarding preventive healthcare issues, wellness, and patient education. In fact, there are studies that show there is greater patient satisfaction with Nurse Practitioners than with physicians. Developing a partnership with patients and encouraging them to participate in their healthcare is central to good medical outcomes.  This also translates to fewer prescriptions, medical and surgical procedures, and less expensive treatment in general. Nurse Practitioners are well suited for this role.  

When the time comes for me to add another provider in my practice, I will look for a Family Practice Nurse Practitioner to join me.   

I have been receiving a lot of e-mail from readers with questions regarding health matters. Please feel free to e-mail me at This e-mail address is being protected from spam bots, you need JavaScript enabled to view it , and as time permits I will try to answer these questions as part of my blog.

REMEMBER, NO ONE CARES FOR YOU MORE THAN YOUR HEALTHCARE TEAM!

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