What Will Happen When Patients Morph Into Customers: (Hint: It Ain’t Gonna be Pretty)


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If plans to improve the U.S. healthcare system take hold, look out for one huge, unintended consequence. “Patients” will morph into “customers.” At which point, all hell will break loose. The change will shatter the patient-doctor relationship mold that’s existed since the dawn of time–and replace it with a diametrically opposed model that will drive many doctors themselves to seek treatment.

Provided healthcare evolves in its most likely direction, two changes in particular will help reverse the traditional relationship.

1. Customers will shop doctors (and hospitals, too): Monetary incentives will motivate healthcare consumers to comparison shop for the best price/value equation–and providers will have to supply cost and performance data to insurance companies and/or government for decision-support.

2. “Patient advocates” will coordinate care provided by multiple physicians: These folks, who will likely come from the ranks of PAs (physician assistants) and RNs will coordinate care among multiple providers–including having a say in determining what treatment (including medications) patients should receive and what they shouldn’t.

A frontal attack on physician ego, for those with big egos.

Physician resistance

Will physicians resist? You betcha, they will. But they’ll find themselves lacking leverage if all this plays out. Customers will contract with insurance companies or a government entity (or both) for health care coverage. Customers will choose suppliers. Patient advocates will nip inappropriate treatment in the bud. Leaving physicians to be relegated to…physicianing. Moreover, declining employment is stripping more and more consumers of their health insurance, creating immense pressure on the dyke holding back health care reform. All the bromides saying we can’t change this or can’t change that are about to be wiped away in the flood. Physicians can’t hold it back. Not for very long.

The beginnig of the end

Hey, the dyke is already leaking. Most perqs traditionally provided by medical salespeople, especially pharma reps, are now illegal. Physicians now face heavy pressure to divulge all their financial relationships with drug and device makers. Insurance companies have started rating physician cost and performance. And thanks to anticipated new transparency regulations, physicians will soon have to divulge their financial interests in clinics where they’re referring customers. But customers–or their advocates– will be making those decisions anyway.

And here’s another foot that looks likely to drop. Talk has already started about restricting physician authority to order extremely expensive end-of-life treatments that only marginally contribute to quality of life or extended life. The percentage of our total health care tab spent within the last six months of life is staggering (I just wish I could remember what the hell it is). Anyway, the number is so big that we can’t afford health care reform without addressing these costs.

Less business for oncologists and the like. And a huge kick in the gut for pharma.

Let’s not cast too wide a net

But please don’t think I hate physicians. I love my new internist–who rescued me from a lazy GP who told me the pain in my shoulder was arthritis when my right arm was close to falling off. And I love my new orthopod, who rescued me from a “chop shop” that told me I needed immediate surgery on both shoulders, the left one first. Turns out my left shoulder will not likely need repair during my lifetime (my baseball pitching career, which is how I originally injured the thing, is long over). And in a related area, I love my 4′ 10″ Vietnamese boat-person dentist, who declaratively told me that the bridgework costing thousands my prior dentist insisted I needed was totally unnecessary. Good to get rid of him, though, after he failed to x-ray my jaw (although I’m sure I was charged) and see that my wisdom teeth didn’t go straight down, but curled way back under my lower teeth in front. He wound up yanking them out with plumbing tools–under Novocain–after which we nicknamed him “Idi Amin.”

Yes, there are wonderful physicians out there. I’m lucky to have some of them. Now. And I suspect that these folks will turn out to be the least resistant to change. But as for the other ones…


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