When it comes to health care, relationships do matter.

When it comes to health care, relationships do matter.

By THOMAS S. BONIFACE

Special to the vindicator

In the debate on health care, there is no shortage of opinion, with widely varied explanations of causes and solutions. One fact that is not disputed is that the provision of health care has become a significant portion of the economy, so significant in fact that it can represent the largest single economic sector in a community. Youngstown is such a place, where the hospitals represent the largest employers in our area.

Agreement also is found in the importance of the relationship between patients and their physician, which if respected and encouraged generates an environment of health and well being. Continuity of care minimizes chance of miscommunication, enhances patient compliance, and results in greater understanding on the parts of both patient and provider, all of which correlate with optimal outcomes and improved patient safety.

Cost over quality

Unfortunately, our system of health care delivery, as it has evolved, threatens both of these important factors. Cost and efficiency are emphasized over quality, exemplified by increased reliance on “physician extenders” (e.g. “assistants” or “practitioners”), or worst yet, “telemedicine,” wherein patients are not even given the opportunity for a real encounter with the supposed professional who is taking responsibility for their life or limb. This is due in part to the idea that health care, especially procedure-oriented care, is increasingly seen as a commodity, which is a dangerous perception, since results of procedures actually correlate best with the amount of time the patient spends in contact with the surgeon before surgery occurs, for instance.

While it has been suggested that the use of the Electronic Medical Record (EMR) may obviate some concerns, this premise is theoretical — physicians who are using EMR do not find it safer or more efficient. EMR has never been shown to improve outcomes or safety, and will not replace the essential importance of a real relationship between a patient in need and a physician interested in helping them.

The difficult economic climate may be a further threat to our local system of care, for both obvious and not-so-obvious reasons. Financial difficulties can be even more pronounced for the largest businesses and institutions than they are at these times for smaller more local concerns, which may not have committed to grandiose expansion schemes and massive overhead. This is seen in major changes at seemingly immune monoliths like Harvard, which for the first time in generations is making budget cuts, and like the Cleveland Clinic, which is sending out “assistants” with video cameras to outlying areas such as Wooster and Youngstown in an effort to capture more revenue to feed their gargantuan appetite. This intrusion by and for a profit-generating entity stands in contrast to, and in conflict with, our local community hospitals and physicians whose mission is to provide comprehensive care to the people of the community where we live, which care is provided without regard to whether payment will be received, again in contrast to what is expected by the Clinic.

Health care that is provided in the context of a relationship between a patient and physician is unquestionably the ideal we should pursue — it is as a rule safer and more effective, and is furthermore an asset to the local economy. Changes in the delivery of such care threaten the foundations of quality, safety, and access to care, and should be avoided except in the most extreme or unusual of circumstances. These fundamentals are vitally important as we consider our health care on all levels — national, local, and personal.