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Does your healthcare provider know you?

The U.S. health­care system today is increas­ingly embracing tech­nolo­gies and inno­va­tions that value speed, effi­ciency, and cost reduc­tion. North­eastern Uni­ver­sity soci­ol­o­gist Tim­othy Hoff says it’s being assumed that this trend is leading to a more patient-​​centric system.

But it’s not: according to Hoff, we’re cre­ating a health­care system that is much more trans­ac­tional and imper­sonal, rather than one focused on max­i­mizing rela­tion­ship quality and values such as trust.

“You could argue the system feels more dis­con­nected and per­son­ally alien­ating than ever before,” says Hoff, an associate pro­fessor of man­age­ment and orga­ni­za­tional devel­op­ment, health­care sys­tems, and health policy, with joint appoint­ments in the D’Amore-McKim School of Busi­ness and the School of Public Policy and Urban Affairs.

Hoff’s research focuses pri­marily on the human con­nec­tion in healthcare—that is, the rela­tion­ships and social bonds patients and health­care pro­fes­sionals build together. He is part of the North­eastern Uni­ver­sity Center for Health Policy and Health­care Research, which fos­ters inter­dis­ci­pli­nary research and edu­ca­tion per­taining to health policy and healthcare delivery.

From vir­tual care tech­nolo­gies to mobile health apps, health­care today looks much dif­ferent than it did 10 or even five years ago. And Hoff says these inno­va­tions aren’t the problem—it’s that our health­care sys­tems, both in the U.S. and else­where around the globe, are relying too heavily on them, and not as much on building a strong provider-​​patient relation­ship. He says this flies in the face of what he’s learned from talking to patients and health­care pro­fes­sionals, both of whom value that rela­tion­ship and become dis­sat­is­fied when it falls short.

“Tech­nology such as elec­tronic health records and mobile health apps can fur­ther the depths of an already solid provider-​​patient bond, but it can’t replace it,” he says. “On its own, it deem­pha­sizes the value of human con­tact and relationship-​​building, both of which pro­duce lots of ben­e­fi­cial things for patient care.”

Hoff recently pub­lished a research article in Mil­bank Quar­terly, the world’s leading health policy journal, for which he inter­viewed health­care pro­fes­sionals deliv­ering patient-​​centered med­ical home care to older adults and ana­lyzed how these expe­ri­ences shaped the staff’s thinking, learning, and future actions in imple­menting such care. He found that there isn’t a one-​​size-​​fits-​​all approach to making med­ical home imple­men­ta­tion work and sug­gested that assess­ments of and rewards for this type of care should include more recog­ni­tion of the value of its social and rela­tional com­po­nents. The med­ical home model, he said, is a key inno­va­tion of U.S. health reform.

This work leads into Hoff’s forth­coming study focused on exam­ining the changing nature of the patient-​​physician relation­ship through a social psy­cho­log­ical lens. For 18 months, he expects to inter­view cur­rent and retired doc­tors, nurses, phar­ma­cists, and edu­ca­tors about their patient-​​care expe­ri­ences, with ques­tions focusing pri­marily on aspects of the patient-​​provider relationship.

He likens the study to an arche­o­log­ical dig, hoping to cap­ture a base­line of data about what the provider-​​patient relation­ship used to be like, what it looks like now, and how it is evolving. The find­ings, he says, could inform both healthcare policy and management.

This all comes as the U.S. rolls out the Obama administration’s Afford­able Care Act. Hoff says Amer­i­cans’ greater access to health­care is a major step for­ward for the country, but he wor­ries that despite this law’s best inten­tions, it will provide greater access to a system that in his view increas­ingly sees patients as wid­gets and is under-​​resourced to provide good long-​​term, rela­tional care.

How can the health­care system get back on the right track? In Hoff’s opinion, “It’s about first com­mit­ting to a set of goals focused on what we want the patient-​​provider rela­tion­ship to be. Once we do that, the tech­nolo­gies and inno­va­tions get built to serve those goals. But we haven’t clar­i­fied these goals yet. For example, the phrase ‘patient-​​centric care’ gets thrown around a lot, because it’s assumed we all know what it means. But no one knows what it means. It’s become a mar­keting pitch insurers, hos­pi­tals, and prac­tices use to get business.”

Oth­er­wise, he warns, impor­tant parts of the system such as pri­mary care will con­tinue evolving into a highly unrewarding expe­ri­ence for everyone involved. “We’ll have a health­care system in which elec­tronic health records will be able to show that you’ve had the same doctor for 15 years,” he says, “but you’ll prob­ably never see that doctor and when you do, he or she will have no idea who you are.”

Hoff’s work focuses largely on pri­mary care, though he sees sim­ilar trends occur­ring in the arena of spe­cialty care. However, he points to two areas where we can learn some­thing valu­able: end-​​of-​​life care, in which patients and care­takers often develop deeper rela­tion­ships and trust within short periods of time, and pedi­atric care, which he says can set a foun­da­tion to build con­ti­nuity of care for a person’s entire life.

Hoff also notes that patients are often iden­ti­fied as “con­sumers” in dis­cus­sions of health­care eco­nomics, pointing for example to New York Times colum­nist Paul Krugman’s 2011 op-​​ed taking issue with this label. For his part, Hoff is focused less on the term itself and more on what it implies—that industry has a larger say than health­care pro­fes­sionals in how to improve health­care in America.

“I don’t dis­agree at all with calling patients ‘con­sumers,’ as long as we under­stand that they’re not the same as people shop­ping for smart­phones,” he says.

– By Greg St. Martin

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