The doctor-patient relationship is quite unique and has long been a topic of discussion.
The “Sick Role”
In 1951, Harvard professor and renowned social psychologist Talcott Parsons theorized that doctors and patients have partner roles to play during treatment, and that each of these roles carries with it certain privileges and obligations.
Central to Mr. Parsons’ model is the belief that patients must trust their doctors and accept their judgment without question.
This widely debated theory later became known as the “Sick Role.”
Under the “Sick Role,” the doctor is expected to:
Act completely in the welfare of the patient, applying any skills he or she might have, and be guided by the rules of professional behavior throughout.
Act with great autonomy and do what he or she considers best for the situation at hand.
The patient is expected to:
Be motivated to return to a healthy state, and to offer any and all information that might help the doctor in accomplishing that goal.
Trust a doctor’s opinion, heed the advice he/she is given and follow all behavioral recommendations.
Most importantly, the patient is to recognize a basic gap in competence that exists between him and his doctors. In other words, the patient should submit, trust and accept a “doctor’s orders.”
So to what extent do patients submit to and trust their all-knowing doctors in our current healthcare context? And what impact might such behavior have on health outcomes and total health expenditures?
Two recent news stories give a pretty ambiguous, unclear answer to these questions.
First, physician rating sites are popping up right and left on the Internet, much to the disappointment of physicians nationwide.
The trend was started in 2006, when the Zagat Survey teamed up with insurer WellPoint to ask plan members to rate physicians in categories such as trust and communication. WellPoint summarized the responses and presented them as scores in a physician guide.
The guide was then made available online to two million WellPoint and Anthem Blue Cross members in three states and to 3.7 million members of Blue Cross Blue Shield of North Carolina.
Since then, more than 40 other physician rating websites have shown up online. They ask patients to rate everything from a doctor’s skill to how much time patients spend in the waiting room. One website, known as RateMeds.com, has listings for 5,400 physicians in Pennsylvania alone. Some of the websites are free, while others require individuals to pay a monthly membership fee to view the listings.
Insurers and web promoters claim that the surveys and websites increase access to information and help healthcare “consumers” make a more informed decision when choosing a provider. They also hope that doctors will read the comments and make efforts to improve their practices in response.
One advocate of the sites, “…sees the ratings simply as an extension of what’s been happening for years: people discussing their doctors, their hospital stay, their dentist, their pharmacy and many other health matters important to their families-only over the Internet instead of over the back fence.”
Doctors, on the other hand, have several concerns.
First, physicians and bioethicists argue that the typical patient does not have a deep enough knowledge of the healthcare field or of the technologies being used to make an accurate assessment of a doctor’s skill or competence in administering treatments.
Second, several of the online forums lack critical oversight:
Patients may post untrue or slanderous information.
Patients may also post anonymously, and most websites do not check on whether a writer was ever actually a patient of the doctor she is reviewing.
In response, physician advocacy groups like North Carolina-based Medical Justice are encouraging doctors to require that patients sign a “mutual privacy agreement” before receiving treatment.
By signing, the patient promises not to post critical comments about the physician online without the doctor’s permission.
These privacy agreements are gaining momentum: An estimated 300 doctors in Florida now require their patients to sign. Close to 100 physicians in Pennsylvania use the forms as well.
This trend paints a picture of a critical healthcare consumer, who is willing to openly discuss his/her doctor’s missteps in an online forum.
This doesn’t sound much like the submissive, deeply respectful patient that Talcott describes.
We’ll look at another example tomorrow that portrays Americans healthcare consumers in an entirely different light- and explore how these different behavioral traits affect treatment outcomes.