Patient Centered Care vs Health Care Rationing

Education is the Doctor’s Best Medicine

Medicine is a science and an art that requires many years of study to create competencies. Physicians spend countless hours honing their craft and learning the art of diagnosis and treatment of disease.

In today’s flat world it seems that anyone with Google believes that they are intimately more qualified than their physician to diagnose, order testing and treat diseases. This is in part due to the influx of advertising medications and treatment options. Today we struggle with superbugs in part due to demand for antibiotics and doctors not standing their ground and saying “No”. Physicians are required to practice defensive medicine in order to avoid lawsuits and to avoid losing a patient to a physician down the street who is willing to give in to every demand…regardless of how off base they may be.

Medical decision making should be done between doctor and patient with the doctor acting as an advocate for the patient and empowering the patient through education.


Drug Advertising Poor Source of Information

The term gatekeeper has a negative connotation due to its relationship to the HMO insurance world. What we all need is a perception change. Many people now believe that after viewing a 30 second commercial they are suddenly empowered with useful information. Physicians need to clarify misinformation when a patient believes info from and advertising is correct and comprehensive as it relates to their particular case.

Time is Short in the Doctor’s Office

Perceptions of the “Gatekeeper” role of the primary physician today are mostly negative, especially given the advent of the ACO as a replacement of the HMO. It’s no surprise that the primary care physician is blamed for rationing the patient’s health care. It does not have to be this way though.

The problem is that our medical insurance system has not addressed the time that it takes to have a real conversation about health care in the payment model. We are rewarding speed as opposed to quality education and patient empowerment.

Even the word Gatekeeper implies that the job is to stop entrance into the system. The primary care physician should be the entrance point into the system, but not for the reasons being put forth by todays insurance dominated system.

Patient Centric Care is a Must

There needs to be a radical shift form Insurance based focus to a focus on the patient. The Primary care physician thus serves as a quarterback for care. In this way, the organization that he/she works for serves as an advocate for the patient. This would shift the focus to the patient where it belongs and alter the perception of the primary physician from gatekeeper to advocate.

Rationing of care is a reality, but it is not the real problem. The problem of rationing is the perception that rationing means that health care professionals do not care about the patient. Rationing happens along all levels in healthcare today. Rationing can be good, such as in the case of not ordering broad-spectrum antibiotics for every ear infection that walks in the door at the pediatrician’s office or in the case of the terminally ill patient that will get no extension or quality of life from continued trials. Doctors do this now; it is just that some are better at explaining the treatment plan. We need to take a cue from our marketing friends and learn to “sell” these best practices to our patients.

Better Patient Communication and Education

With the sale of best practices to our patients we actually empower them to make better decisions based on knowledge. Rationing of care when it fits best practices makes sense; the problem lies in the rationing of care based on cost or access alone. Rationing based on cost alone, i.e.: waiting on an MRI when its medically necessary is unconscionable, but rationing care when a patient demands something that will not alter the outcome is absolutely necessary. We need to change our system to be focused on the patient with the doctor assisting in the education of the patient about the condition. If we shift our focus to the patient and do what is best for the patient and remove the access problems as well as the cost issues we would see savings based on best practices while giving the highest quality care with the patient as the focus.

Dr. Timothy Bain

Tim-Bain-smlPresident and Founder
A sought-after expert in health and wellness–specifically preventative medicine, sports performance and nutrition–Dr. Tim Bain is the founder of Bain Complete Wellness and The Athletes Compound at Saddlebrook. Dr. Bain treats hundreds of professional athletes and has patients of all age-groups. His popular multi-faceted, individualized approach is based on his belief that true health is not merely the absence of symptoms but the presence of well-being in mind, body, and spirit.

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Education Doctorate of Chiropractic – Life University Diplomate of the American Association of Integrative Medicine Certified Exercise Strength and Conditioning Specialist – Texas Chiropractic College Certified Chiropractic Sports Medicine Specialist – Texas Chiropractic College Certified Sports Injury Specialist — Texas Chiropractic College Other degrees: B.S. Biology with a concentration in Psychology – Manhattan College. Memberships Council on Sports Injuries & Physical Fitness of the ACA International Chiropractic Pediatric Association American Chiropractic Association Florida Chiropractic Association American Chiropractic Association Sports Council National Strength and Conditioning Association Defeat Autism Now Life Extension Foundation Honors Summa Cum Laude Chiropractic National Honor Society Biology National Honor Society Psychology National Honor Society Awards International Pediatric Chiropractic Association — Distinguished Research Fellow Brookhaven National Laboratories/NIH — Distinguished Researcher Selected Publications Bain, T.F. (2012), Increasing performance through hip joint optimization, Professional Hockey Athletic Trainers Society Newsletter, Spring Edition, p.7-8. Bain, T.F. (2011), Increasing sports specific performance in children, Hillsborough County Chiropractic Society Journal

Dr. Bain’s Complete Curriculum Vitae