Pulmonary disease has one of the lowest levels of patient adherence for any area of medicine. In a meta-analysis of 569 studies, pulmonary disease ranked fifteenth out of 17 different disease conditions for adherence, with a mean adherence rate of 68.8%. Only diabetes (67.5%) and sleep disorders (65.5%) ranked worse. Adherence is discussed in detail elsewhere in this Supplement (see the article by Horne). However, as an example of the importance of patient-focused care to adherence, it is worth mentioning that in the Medical Outcomes Study, general adherence and adherence to medication, exercise, and diet recommendations in diabetic, hypertensive, and heart disease patients were related to the following: physician job satisfaction (general adherence), number of patients seen per week (medication), scheduling a follow-up appointment (medication), tendency to answer patients’ questions (exercise), number of tests ordered (diet), seriousness of illness (diet), physician specialty (medication, diet), and patient health distress (medication, exercise). All of these factors, except physician specialty and seriousness of illness, can be influenced within the framework of patient-focused care.
Patient-focused care may also have objective benefits for the physician. In a longitudinal, observational study of 4,108 patients, 20% voluntarily disenrolled from their primary care physician’s practice over a 3-year period. The quality of the physician/patient interaction predicted patients’ loyalty, with eight factors significantly predicting patient disenrollment (p < 0.001): trust, interpersonal treatment, physician knowledge of patient, communication, access to care, integration, visit-based continuity, and relationship duration. In a multivariate analysis, patients with the poorest quality physician/ patient relationship were three times more likely to leave the practice over the 3-year period vs those with the highest quality relationships. Therefore, physicians that are able to develop better relationships with their patients are more likely to retain them, an important economic consideration in many health-care systems.
Not all adverse medical outcomes lead to malpractice litigation, and not all malpractice litigation is triggered by an adverse outcome, so why do patients and families sue doctors and hospitals? One study tried to address this question by looking at discovery depositions in 67 cases of malpractice against a metropolitan medical center.