In this episode of Kentucky Health, host Dr. Wayne Tuckson welcomes Dr. Monalisa Tailor, the current president of the Kentucky Medical Association. Dr. Tailor discusses challenges to the physician-patient relationship in contemporary society, many of which have been exacerbated by the COVID-19 pandemic.
Factors Contributing to an Erosion of Trust Between Patient and Provider
Health care providers currently practice in an environment where skepticism of authority figures is rampant, says Dr. Tailor, an internist and KMA president until fall 2023. Tailor believes that asking questions of those who offer medical advice is always necessary to learn about a specific medical procedure or prescription. But the spread of misinformation pervading society today creates a level of distrust of physicians that is unwarranted, she adds.
“Thanks to Google and to all of our social media, sometimes that (physician-patient) conversation becomes very skewed, and it’s hard to break that wall with a patient,” she says.
Immediate access to so much information online can lead to patients forming inaccurate opinions about many medical topics, Tailor says. For example, the troubling rise of vaccine skepticism coming out of COVID-19 is leading people to refuse a range of vaccinations, even those for diseases that weren’t controversial before the pandemic.
While patients can obtain helpful information from Google and other Internet resources about their specific health problem, Tailor says they may also get an inaccurate – even frightening – sense of what’s to come.
“Let’s say I’m Googling my symptoms, and maybe it will give me an idea of some things that could be of concern, maybe it helps me define that word within my radiology report that just didn’t make sense,” she explains. “But where Google becomes more of an enemy rather than a ‘frenemy’ is where you put in your condition and it’s giving you a life expectancy.
“Google doesn’t know if you have six weeks left to live – it shouldn’t be telling you that. Heck, providers shouldn’t be telling you that. We don’t know, we don’t have a crystal ball... Trying to reassure the patient in that situation, that becomes much harder instead of them just coming in and having a conversation about your diagnosis in person.”
Short medical appointment times are an even bigger concern, says Tailor. Many physicians have full and rapidly-paced schedules, causing face-to-face meetings between doctor and patient to last just a few minutes.
“It does feel like you’re constantly churning in and out with patients, and it’s that time that you’re able to spend with them to explain what’s going on, and really address their concerns,” she explains.
Tailor says she tries to allot 30 minutes for each patient appointment, but acknowledges that’s difficult for many doctors. After a full day of appointments, physicians may work extra hours to keep up with paperwork and other duties. In fact, she recalls a recent study that found primary care doctors need 27 hours each day to complete all their work. That leads to burnout, which can further erode the physician-patient bond.
“We call it ‘pajama time’ now,” Tailor says. “Because that’s the time you’re spending after work to complete documentation, take care of those lab results, prior authorizations, and emails, the OR (operating room) reports – all of those things are happening after hours.”
“Now, a typical day would be 24 (hours), so when are you supposed to eat, sleep, spend time with your family, and get your own wellness in?” she asks.
The current health care system has many inefficiencies that cause some physicians consider whether to leave the profession, according to Tailor. She also points to another recent study that says 90 percent of pharmacists in the U.S. consider themselves burned out.
“Prior to the COVID-19 pandemic, burnout was already on the rise amongst all health care professionals,” Tailor says. “And then we had the COVID-19 pandemic. And I know we don’t want to think about it or talk about it, but as health care providers specifically, we were the ones on the front lines.”
Tailor recalls how several colleagues who were intensive care unit (ICU) nurses were permanently affected by watching patients die alone in their hospitals during the early months of the pandemic. Since family members were prohibited from visiting, nurses often arranged video chats so patients and loved ones could say their farewells.
“That is a different burden to bear, and is its own form of trauma,” she says.
What Doctors Need to Better Serve Patients
Tailor, who is from Bowling Green, says that while the medical facilities and personnel in Kentucky’s third-largest city are sufficient for Warren County residents, many patients travel there from surrounding areas to receive care. The shortage of physicians and clinics in rural Kentucky is longstanding, Tailor says, but has gotten worse since the pandemic. Many young physicians that are burdened with medical school debt are seeking positions with competitive pay, which are more often located in urban areas, she notes. Plus, younger medical workers may value the lifestyle amenities offered in places such as Louisville or Lexington.
“In a rural setting, yes, patients are very grateful – they need primary care,” she says. “But there’s also fewer students going into primary care (as a discipline). It doesn’t pay as well as some of your surgical sub-specialties, or cardiology or gastroenterology. And as a result you see a lot of residents going into those spaces.”
As a primary care doctor, Tailor is well aware of the constant stresses associated with being the first person of contact for hundreds of patients. Many primary care physicians, especially in rural areas, are isolated to a large extent: they have no one with whom to share ideas about patient treatment or other concerns. “It’s really the collaboration that helps you in your practice,” she says.
One option to alleviate stress and burnout is to adopt a concierge health care model, and some physicians have made that transition, Tailor says. A concierge physician offers constant access for patients as well as longer visits and more personalized care, but for an additional fee, she explains.
“I think the hard part there becomes you also have to have the dollars to do it,” Tailor adds. “And we know that not everybody has that luxury… especially when we’re in a state where we need as much care as possible.”
To address this shortage, Tailor believes that medical school debt relief programs should be increased to compensate for practicing in underserved communities.
Another problem affecting the quality of physician care is prior authorization requirements. Prior authorization occurs when a physician orders a novel medication or procedure to address a patient’s specific medical issue. If that treatment is not covered by the patient’s insurance, the physician must submit paperwork to the insurance company – or even be required to call them – and then await a decision on whether it will be approved or not. Many times, the drug or treatment will not be approved until ones that are and have been covered by insurance are tried first.
Tailor says this prior authorization requirement often results in poor patient outcomes, especially for individuals who could be helped by new treatments and cannot wait long for approval.
“We want to work with our insurers and we want to work with our health care providers to ease this burden,” Tailor says, “because in the end, it’s the patient who’s suffering – it’s the patient who’s not able to get that imaging or the patient who’s not able to get that medication or maybe it’s a surgical procedure. We need to improve this.”
