The role of professional intimacy in patient experience

Steven Merahn, MD, FAAP, chief medical officer, Centria Healthcare, thinks that approaching the discipline of medicine and the administrative work of healthcare can and should be infused with a healthy dose of communications.

“It's been my aspiration to bring that knowledge and understanding of strategic communications and how to leverage communications to change the knowledge, attitudes and behavior of target audiences back to healthcare,” Merahn said on a recent MGMA Insights podcast interview with Daniel Williams, MSEM, MBA, senior editor, MGMA.

Working earlier in his career on information technology, including clinical decision support platforms, Merahn often worked to promote the concept of “technology-enabled care” but found some unintended consequences of changing workflows with added IT in the clinical space.

“Whether it's the way we captured billing and coding, the way that we were asking clinicians to document in order to meet outside expectations for documentation … technology was interfering with the capacity for the doctor and patient to connect,” Merahn said.

The demands of fee-for-service models of care caused such a focus on keeping the waiting rooms and appointment calendars full that Merahn saw entire segments of the patient population not being seen in the clinic in more than a year’s time.

That didn’t mean they weren’t getting healthcare, though. “A number of the patients with COPD had been making many trips to the emergency room and had been hospitalized a number of times in the prior year, yet they had not come into the primary care office,” Merahn noted. “We had to invest a little bit of extra time and attention to get them stabilized to the point where they were now coming into primary care and coming into ambulatory specialty care, but not necessarily using the local hospital as their as their primary care source.”

Professional intimacy

Merahn stresses the importance of “continuity and connection” with patients as part of his focus on what he calls “professional intimacy.” Armed with a physician, a medical assistant and a telephonic patient care coordinator, Merahn found that hospitalization rates and emergency room utilization dropped when that core group of three in primary care delivered 75% of the patient’s care.

“When we know [a patient] so well, and when they know us so well, there's a level of affinity, a level of acceptance and commitment to the care plan that can really have a positive impact on the patient’s quality of health,” Merahn said. “When the care is delivered more consistently by the same team, we can really have an effect on people's health.”

Broadening the concept of care

Merahn said he personally sees the increasing focus on social determinants of health (SDoH) as a positive move to being more inclusive in terms of what providers consider healthcare.

“This is an important part of our capacity to humanize the relationship between doctors and patients,” Merahn said. “We don’t want to look at patients as just a biomedical phenomenon; we want to see them as a person, not as their condition. I think we need to embrace the fact that the medical community and practices really shouldn't shy away from addressing some of the outside forces that are influencing the way we deliver care.”

Similarly, Merahn noted that recognition of the increasing financial responsibilities for patients can be another key consideration to ensuring patients get to care and reach their care plan outcomes. “One of the things that really frightens me sometimes is the number of reports that have come out … that people will delay care due to financial issues associated with high-deductible plans,” Merahn said, noting that appointment reminders can help humanize the providers and update the perception the patient has about a clinic visit. “We've got to help people make these kinds of choices. Physicians have a lot of social capital that can be leveraged to their patients’ benefit.”

Overcoming a resistance mindset

The first five minutes of a patient visit can be the key to building professional intimacy, Merahn said — something as simple as the physician sitting at eye level with a patient can have a big influence on the power dynamic between the two individuals, which helps put patients at ease.

Basic changes in questions can yield better outcomes, as well, such as asking a patient how he or she is doing rather than leading off with, “Why are you here today?”

“By taking that five minutes, and it really is no more than that, you humanize the interaction between the practice and the patient,” Merahn said. “It changes the perception of not just why they're there, but it changes the perception of the level of connection, the fact that the physician is simply wanting to listen for five minutes and then move on. You’re really saying there that my relationship with you matters.”

Of course, investing that amount of time in a patient encounter may cause some concern for the way things have been done, which requires getting out of a “resistance mindset” about how practice flow might be disrupted.

“The benefits on the back end are a higher level of affinity with the practice, a higher level of loyalty; you're going to have significantly less conflicts,” Merahn asserted, which ultimately will lead to improved patient satisfaction scores.

Quantifying culture

While healthcare is a business and medicine is a profession, Merahn is careful to point out, the role of strategic communications to achieving better results is as much an evidence-based practice as other areas of the art and science of care delivery. “Once you can absorb that, then you can simply find where in the workflow you can insert these moments to build connections,” Merahn said. “If you look at it that way, all of the sudden the time commitments look significantly less.”

Small, subtle changes such as those can help providers “recapture” why they went into medicine in the first place, Merahn suggests. “Encourage your staff, whether it be in the front office or the back office, to think about this as a philosophical decision that practices make, and to say that overall, our value to our patients and our value to the payers is based upon this level of connection with our patients,” he says.

Hear Dr. Steven Merahn talk about "professional intimacy" and its impact on the patient experience in this MGMA Insights podcast.