Managed Care

Addressing a Nontechnical But Very Important Skill

John Marcille

Physicians often find that to survive and prosper under managed care, they must meet new requirements whose necessity they may not, in their secret hearts, concede.

We all know that there is a certain amount of suspicion of capitation, utilization review, length-of-stay limits and — well, you get the picture. We know, too, that some physicians are skeptical of managed care organizations' oft-repeated pledge to deliver high-quality care.

Wouldn't it be nice for plans, patients and physicians to be able to pull in the same direction, at least some of the time?

Our cover story sets out one area in which this ought to be possible. Anecdotal evidence and academic research both indicate that many physicians don't listen to patients carefully enough, and that the consequence is cost- ineffective medicine in the form of premature diagnosis and inappropriate treatment.

Let's accept the premise. As contributing editor Chuck Appleby found in researching the problem, physicians definitely can improve their listening skills. Good-listener classes provided by for-profit and not-for-profit groups have been able to change behavior quickly and easily.

When doctors listen better, patients are happier. Outcomes, we are told, improve, even as unneeded tests and therapies are avoided — a boon to patient, doctor and plan.

Some doctors are already superb listeners. Others may refuse to consider that their listening skills need improvement, engaging in the same form of denial as those who automatically assume that their patient panel is sicker than average when the HMO sends them them an unfavorable utilization report.

Imagine a forward-looking health plan providing good-listener classes for its physician panel. A small investment of plan money and physician time could boost patients' satisfaction with plan and provider. Not a bad deal, wouldn't you say?

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