Town Times Requester



State Sen. Len Fasano.

Saving the patient/doctor relationship

There is a problem with our healthcare system today that transcends the political divide over Obamacare and the debate about how to best deliver quality, affordable care to every patient in America. The Greater New Haven region is fast becoming a microcosm for this problem and what it could mean to the future of the patient/doctor relationship and, more broadly, the future of health care in our country.

My father, the late Dr. Leonard A. Fasano, M.D., practiced internal medicine out of his Whalley Avenue office for more than half a century. He was also associated with both Yale-New Haven and Saint Raphael’s hospitals. If you were my father’s patient, you knew who your doctor was and you knew that he cared. He loved practicing medicine, but he loved the intimacy of the patient/doctor relationship more. And he knew that the close relationship was vital to his patients’ health.

After my father passed, one of his patients relayed a story about being on the phone with him and describing the symptoms of his own illness. During the conversation, my father overheard the patient’s wife coughing in the background. Having counseled the patient on the phone, my father changed the course of the conversation and asked how long his wife had been coughing and what other symptoms she was experiencing. My father told the man to bring her in for a check-up, where he quickly diagnosed her and cured her. This would not have happened if the patient was on the phone with a switchboard operator at an emergency room, or some other nameless, faceless voice at a city hospital.

It is tough enough on private medical practices to try to survive in an environment where insurance companies dictate fees. Private practices, like my father’s, have served families for generations and bring more than institutional knowledge to their craft; they bring personal knowledge, history and empathy. But, they are going the way of the dinosaurs and not just because our lives are too busy to devote time to choosing a good family physician and the pressures exerted on them from insurance companies. Now they, and every patient, face a new threat, family physicians and their practices being bought out and closed by large institutional hospitals. The result is not just a lack of choice for medical care but also the erosion of the close family patient/doctor relationship.

Yale-New Haven Hospital, in particular, has made a business of buying up small private practices throughout the New Haven area. They have exerted various pressures on our medical community that are forcing doctors out of private practice. Those efforts include, among the more direct methods, making the principal physician a financial offer they can’t refuse, providing them with a prestigious association at the hospital, and then removing any financial incentive for them to keep their private practice open. Compare the yellow pages from a decade ago to the yellow pages of today and you will see what I mean. Yale-New Haven Hospital has bought out most of the best oncologists and heart doctors in the region and they are beginning to target orthopedic physicians.

Why is this bad for our health care system? For one, it dilutes the patient/doctor relationship. The physician who may have served your family for generations and whose office was down the street from you, is no longer there. What is worse is that it is inconvenient, particularly for the elderly, to see a doctor when they need to; when they know their only option is to travel into the city and see a relative stranger at a large public hospital.

The pace at which Yale-New Haven Hospital has gobbled up private practices also reduces competition in the marketplace and increases costs to patients. A constituent of mine was recently charged two co-pays (a doctor’s fee and a facility fee) by Yale-New Haven Hospital for a visit that used to cost just one co-pay through their family physician.

Twenty or 25 years ago, I remember my father warning of the day when family physicians and private practices would become a thing of the past. He feared that a focus on profits over outcomes would result in patients being viewed as “numbers instead of people.” If we do not do something soon to refocus our priorities on outcomes over profits, I am afraid that his fear may be realized.

What is happening in the New Haven region is akin to a monopoly and it needs to be stopped, or regulated. To be sure, Yale-New Haven Hospital is one of the preeminent medical institutions in the world and they should have a seat at the table when we look for a solution to this problem.

But, let us take steps now to improve health care by ending this dangerous trend, restoring the patient/doctor relationship, and re-establishing the New Haven region as a model for healthcare delivery in America.

State Sen. Len Fasano, R-34, represents the communities of East Haven, Durham, Wallingford and his hometown of North Haven in the Connecticut General Assembly.

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