Dr. Barbe: We need more time with patients, less at the keyboard

Andis Robeznieks , Senior News Writer

While sitting between two U.S. senators, AMA President David O. Barbe, MD, MHA, told a Washington audience that government can a play a role in strengthening the “almost sacred” patient-physician relationship by reducing physicians’ administrative burdens, increasing cost transparency and facilitating electronic health record (EHR) interoperability and data liquidity.

“Physicians have become data-entry clerks,” Dr. Barbe said, noting how they spend two hours on EHR and deskwork activities for every hour they spend face to face with patients. “That’s upside down.”

Government has a role in reducing that type of burden and in helping to make the data that are generated work for the health care team instead of having data collection act as an obstacle to overcome.

Dr. Barbe made those remarks at an event, “The Doctor-Patient (and Government) Relationship,” hosted by the news outlet Politico. He appeared on a panel with Sen. Bill Cassidy, MD, R-La.; Sen. Jeanne Shaheen, D-N.H.; Alan Balch, CEO of the National Patient Advocate Foundation; and Aretha Delight Davis, MD, co-founder and executive director of Advance Care Planning Decisions, a nonprofit foundation that provides education videos to support shared decision-making.

The program took place before the Senate Republicans decided to cancel a planned vote on a measure, co-authored by Dr. Cassidy, that would have repealed and replaced the Affordable Care Act. When asked about the bill, Dr. Cassidy said voters frustrated by problems with the ACA deserved to see a Senate vote on the measure.

“I think that people—those who want the Affordable Care Act replaced—they want a vote,” he said.

The AMA opposed the legislation, known as the Graham-Cassidy-Heller Johnson Amendment to the American Health Care Act, a bill that the House passed this past spring.

In later discussion, Dr. Cassidy would declaim the barriers EHRs put between patients and physicians.

He noted that, particularly when delivering bad news such as a positive cancer diagnosis, physicians should be looking into their patient’s eyes and not “tapping on a computer.”

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A gastroenterologist and liver specialist, Dr. Cassidy also highlighted the idea of team-based care and said that cardiologists have been leaders in this practice model.

Dr. Barbe also talked about how Medicare  can enhance team-based care—which, he said, is a model that the AMA supports—and help address workforce issues such as the physician shortage.

He also spoke in favor of shared decision-making with patients, noting that medicine has been in a 30-year process shifting to this partnership model of care and away from a paternal relationship where physicians “held all the knowledge” and patients faithfully followed instructions.

“We know now that this is the best model,” Dr. Barbe said, noting that superior outcomes come from shared decision-making and that evidence from the Mayo Clinic and the Dartmouth-Hitchcock Center for Shared Decision Making supports this.

Shaheen, the New Hampshire Democrat, said she became interested in shared medical decision-making because of the Dartmouth Center, which is in her state. She called shared decision-making a “no-brainer from a policy perspective” because physicians and patients are happier—and because patients who take part in this more collaborative model tend to choose less invasive, less costly treatment options.

Dr. Barbe added, however, that more information is needed for shared decision-making to work better.

“Transparency, I think, is the key,” he said. “Physicians need to partner with patients to navigate a very complex system.”

As a family physician, Dr. Barbe explained how this navigation is impeded by a lack of knowledge about the specialists in a patient’s insurance network and how much the care those specialists provide will cost.

Shaheen said New Hampshire has been a leader in the trend toward transparency by posting provider cost and quality data on the internet.

There was also discussion about co-creating a custom care plan that reflected patient values and goals as well as payment based on customized patient-specific quality measures.

By this time, Dr. Cassidy had left the event, and Shaheen lamented how the Congressional focus on ACA repeal has prevented these sorts of ideas from being explored at a national policy level.

“We can never get to that discussion until we get past this ‘Groundhog Day’ experience,” she said, referencing the movie in which actor Bill Murray’s character lives the same day over and over again.

Shaheen also lamented how a bipartisan effort led by Sens. Lamar Alexander, R-Tenn., and Patty Murray, D-Wash., to stabilize the personal health insurance marketplace was “derailed” by the latest repeal-and-replace effort. After it was announced that the Graham-Cassidy measure would not be voted on, Dr. Barbe released a statement expressing hope that bipartisan effort could be revived.

“While we are relieved that the Senate did not adopt legislation that would have harmed patients and critical safety net programs, the status quo is not acceptable,” he said. “We urge Congress to renew a bipartisan effort to address shortcomings in the Affordable Care Act. In the short term, that means stabilizing the individual marketplace to achieve the goal of providing access to quality, affordable health coverage for more Americans."