Are your specialist friends with your primary care physician? Helps – Consumer Health News

WEDNESDAY, Jan. 4, 2023 (HealthDay News) — Patients may be happier with their care when their doctor is training with the referred specialist, finds a new study.

Researchers have found that when patients see a specialist, they generally give better ratings for their care if that doctor went to medical school with their primary care provider. In general, they said, these professionals take more time to talk to them, give clear explanations, and include them in health care decisions.

If that sounds confusing, the researchers said the explanation could be rather simple: Doctors are just like everyone else, and keep playing their game when their peers are “watching.”

“Doctors are people too, and most of us want to perform our best in front of a familiar and respected colleague,” said one senior researcher. Dr. J Michael McWilliamsfrom Harvard Medical School and Brigham and Women’s Hospital, Boston.

“It makes you feel good if you’re able to excel in those situations,” he said.

Of course, no one expects primary care physicians to only refer patients to their old friends from medical school. But McWilliams said the findings raise questions about how to improve peer relationships and accountability among clinicians, and whether that can improve patient care.

Traditionally, efforts to enhance the quality of patient care have centered on financial incentives. But that falls short when it comes to individual doctors, according to McWilliams.

“When we think about how doctors are motivated, we need to think about what motivates humans,” he suggested.

The study was published online on January 3 JAMA Internal MedicineAnd the Electronic health records are used for more than 8,600 patients in the same large health system. All were referred to a specialist by their primary care physician sometime between 2016 and 2019.

In about 3% of those visits, the primary care physician and the specialist had both trained at the same medical school at the same time. McWilliams said it was a “predictor” of whether the doctors knew each other. However, it is not certain that they did.

Despite this, the researchers found that patients reported different experiences when their specialist “shared” the training with their primary care physician.

On average, they gave a 9 percentage point higher rating of the quality of their care, compared to other patients. Researchers said this is the difference between a specialist being middle or near the top of the heap.

In general, these patients were happier with the intangibles, such as the friendship of their specialist, and were more likely to feel that the doctor explained things clearly and involved them in the decision-making.

Furthermore, there was some evidence that these specialists changed objective aspects of care: they were more likely to prescribe medication than specialists who had not shared training with the referring physician.

However, this is not necessarily a good thing, he said Dr. Don Goldmanchief scientific officer emeritus at the nonprofit Institute for Health Care Improvement in Boston.

He noted that there is no way to know whether or not those prescriptions are actually best care.

Goldman, who wasn’t involved in the study, had a few more caveats: It’s not known whether patients end up doing better if their doctors participate in the training. Co-training does not automatically mean an actual peer relationship.

So it would be a “jump” to conclude that patients get better care when their primary care physician and specialists are friends, according to Goldman.

However, he agreed that it is important for primary care providers and specialists to have trusting relationships.

Goldman pointed to the example of “care agreements” — where primary care physicians and specialists have agreements about their protocols and expectations, with the goal of providing the best care.

It might also be helpful, Goldman noted, for doctors to grab a cup of coffee together.

“Get to know each other,” he said, “by whatever means you want.”

McWilliams notes that during training, doctors routinely work in teams, but once in practice, they are often isolated. He said health care systems can “get creative” in breaking this isolation, even through something as simple as moving workstations from exam rooms to common areas where doctors can interact.

Another tactic, McWilliams said, could be “regular, group” case discussions to help clinicians learn from each other.

However, no one is suggesting that referred patients make sure their doctor is a friend of the specialist. In addition to the issue of practicality, there are plenty of other factors that influence the quality of patient care.

As an example, Goldman pointed to studies showing that black patients tend to receive better care when their physician is also black.

Regardless of the doctor, Goldman said, the broader health care system — which changes things like the timing of patient care, and the flow of information between doctors — has to work well.

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The Cleveland Clinic offers advice on: Questions to ask your doctor.

Sources: c. Michael McWilliams, MD, PhD, Warren Albert Foundation Professor of Health Care Policy, Harvard Medical School, and internist, Brigham and Women’s Hospital, Boston; Without a. Goldman, MD, chief scientific officer emeritus, senior fellow, Institute for Health Care Improvement, Boston; JAMA Internal Medicine, January 3, 2023, online

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