The rise of consumerism and the Internet have radically changed patient/physician relationships. There was a time when people never dared to question a physician's diagnosis or recommendations for treatment. Physicians and other healthcare professionals were placed on a pedestal, and even malpractice suits were infrequent. Sociologists attribute this loss of innocence to the Vietnam War, the Watergate scandal, the dumping of toxic waste, and other events that have caused some to question whether those in authority actually have our well-being in mind. Added to this are the efforts of people like Ralph Nader, who educated consumers to examine critically the safety of products and practices commonly in use. The result is a new group of consumers who focus on wellness, who put responsibility for health in their own hands, who play an active role in keeping themselves fit, and who shop for healthcare services with a critical eye. The powerful explosion of self-care Web sites on the Internet, coupled with unprecedented access to health data and medical research from one's home "24/7" has dramatically changed the patient/physician interface.
Shopping for healthcare services began in the 1980s. Prior to this, people visited the family doctor with whom they had grown up, or they selected a practitioner in the neighborhood. However, with the mobility that characterizes our society, people move frequently, and long-term relationships with healthcare providers are often not possible. Managed care has also impacted the "sacred" physician/patient relationship: physicians may be denied access to the care they think is best for an individual patient and patients may be forced to change physicians when they change employment or when health maintenance organization (HMO) physician panels change. Interest in holistic medicine and the proliferation of public information regarding the prevention of disease have also fueled the consumer-driven market.
One would expect a consumer-driven market to spawn competition among healthcare providers who, in the context of this book, are physicians and dentists, not hospitals. Dentists have historically been savvy about marketing and sensitive to consumer issues and there was a time when physicians had more impetus to attend to such concerns. Today, however, reimbursement for medical care has been impacted so dramatically by managed care and HCFA (Health Care Financing Administration) that just keeping the door open and the lights on can be a challenge. And, to be sure, there are large groups of patients who do not have the luxury of "shopping" for healthcare services: they may be uninsured and happy to receive any care at all. That's the reality. Despite this, the issues raised in this chapter are important and should be considered when remodeling or planning new offices.
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