Health care system eats away at the doctor-patient relationship

Dr. Thea James’s remarkable work at Boston Medical Center in addressing structural inequity in medical care as a means of enhancing outcomes brings up an underlying structural problem across the entire medical care system (“Her health equity message being heard,” Page A1, April 13). The system economically rewards throughput (the number of patients seen per unit time) and procedures rather than the time needed to develop an open and communicative doctor-patient relationship.

While a good physician might understand the tests and evaluations that are indicated by a presenting medical problem, the excellent clinician knows which tests and evaluations should not be done. This is primarily ascertained by delving into details of the patient’s physical, psychological, social, family, and economic history. This process, as James highlights, can lead to collaborative and more effective care.

While insurance companies can easily count the number of patients seen and the number of tests and procedures done, they don’t appear to know how to quantify the impact of excellent physicians on promoting health and wellness and avoiding hospitalizations, or the cost savings realized from not performing unneeded tests and procedures.

In addition, the so-called businessification of medicine has driven more physicians toward specialty practices, in which the need for gathering a health history is more narrowly circumscribed and can be done in a relatively shorter time and where the throughput and procedures are amply rewarded.

The economic structure of medical care in the United States must find a way to promote, support, and reward time that general practice physicians, such as providers of family medicine, internal medicine, and pediatrics, spend face-to-face with patients.

DR. KARL KUBAN Plymouth

The writer is a professor emeritus of pediatrics and neurology at Boston University.