Page 17 - Delaware Medical Journal - January 2018
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THE MEDICAL PROFESSION
TABLE 4: Movement to Team Based Care
Effect on Physician Autonomy, Patient and Physicians
CONSEQUENCES OF TREND
EFFECT ON PHYSICIAN AUTONOMY
EFFECT ON PATIENTS
EFFECT ON PHYSICIANS
a. Physician role systematized
as member of a healthcare team.
Reduced:
Definition of physician’s role limits control.
Favorable: Improved care through additional clinical expertise of team practice.
Favorable: Reduction in “non-physician” work; enhanced clinical support for physician.
b. Traditional patient / physician relationship is broadened to a patient/care team relationship.
Reduced:
As patient relationships are less exclusively focused on physician.
Unfavorable: If trust in the physician erodes with the loss the one-on- one physician/patient relationship.
Favorable: If patient relationship with physician is maintained or replaced satisfactorily with other team member.
Favorable: As care giving burden is shared.
Unfavorable:
If professional satisfaction from relationship
with patients is diminished.
DISCUSSION
The potential effects of the changes
in practice we considered reduce individual physician autonomy in that are traditionally associated with physician autonomy are a result of
that autonomy, the changes we see
could pose major issues for the public. However, to the contrary, there is much and physicians in these changes.8
The decline in physician autonomy
does not seem to necessarily imply a degradation of care for patients or a diminished professionally satisfying life for physicians. Patients and physicians we examined. We emphasize though that conditional. Good organizational design, good management, a commitment to patient-centric care, and attention to
the professional needs and desires of physicians are essential.
The most worrisome area of risk that
we discern is that of patient advocacy.9 The loss of physician autonomy correlates with a potential loss of a
sense of individual responsibility to act as a patient’s advocate. It is reasonable
to hypothesize that there is a causal relationship between the individual responsibility a physician bears in being autonomous and the individual attention that a patient should expect in the form of advocacy by his physician. In a system with reduced physician autonomy, will the patient lose the attention of his physician? Will the physician in her less autonomous state have the individual power to act in her individual patient’s behalf? These are vitally important questions at the very center of the role
of physicians. Especially in larger organizations in which physicians are employed and subject to organizational
TABLE LEGEND
system of care in which a patient lacks an advocate. This loss would be profound. Much of the healing force of medicine is based on the trust that patients have in their physicians. When one cannot trust
a physician to be one’s advocate, that aspect of healing power is at grave risk.
CAVEATS
The nature of our investigation is by
autonomy, at least in the common parlance used in medicine, is imprecise at best.
A similar objection can be made to the term advocacy and to the assertions of physicians. Quality, safety, the structure and capabilities of EHRs, and the evolving nature of value-based reimbursement
all have more rigor developing in their
broad range. This necessarily leads to imprecision in our assertions. Additionally, our views of the effects of the trends are just that, our views, and not based on a
Effects on Patient Benefits Associated with Physician Autonomy
EFFECT ON PATIENT ADVOCACY
EFFECT ON CLINICAL EXPERTISE
EFFECT ON QUALITY AND SAFETY
EFFECT ON INNOVATION
Enhanced: If team norms include expectation for patient advocacy by team members - especially physicians.
Reduced: If physician feels less personally responsible for care.
Enhanced: Well- designed, team-based approaches stimulate the development of clinical expertise across the team.
Enhanced: Well- designed, team- based care reduces risks caused by communication failures.
Enhanced: If team norms encourage innovation and creativity.
Reduced/Unfavorable
Enhanced/Favorable
Mixed
Del Med J | January 2018 | Vol. 90 | No. 1
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