"A growing chorus of discontent suggests that the once-revered doctor-patient relationship is on the rocks."
That's the opening line in New York Times' Health Editor Tara Parker-Pope's series, Doctor and Patient, Now at Odds.
Ms. Pope goes on to say:
"Lately I've been hearing a lot from patients who are frustrated, angry, and distrustful of doctors. Their feelings speak to a growing disconnect between doctors and patients and worries that drug companies, insurance rules, and hospital cost-cutting are influencing the care and advice that doctors provide.
Research shows that even among patients who like their personal physicians, there is a simmering distrust of the medical system and the doctors who work inside it."
(There's also a series of candid video interviews with people who echo these sentiments.)
There are a number of reasons for this increasing "disconnect," some of them articulated by Ms. Parker-Pope.
I fear that much of the solution will not be found in the direction that many physicians and policymakers are looking. Yes, access to healthcare for all Americans will improve the lot of many people, as will improved drugs and better procedures. But the ailing doctor-patient interaction will not be cured by any of these developments.
In my view, the solution to the unhappy state of the doctor-patient relationship will not be found through advances in technology: the newest robotic surgery, a better defibrillator, a new statin drug, the next best chemotherapeutic agent. It will not be found by adding a new wing to the hospital. It will not be found through the reorganization of healthcare delivery achieved by converting primary care and specialty practice into an arm of hospital care. It will not be improved by employing "hospitalists." It will not emerge from legislation controlling insurance company practices. It will not come from increasing marketing dollars spent by drug companies.
I believe that solutions will come from shifting the model of care from a paternalistic, "I'm the doctor and I'll tell you what to do" approach, to the doctor-as-advocate-and-supporter of the patient. The physician should act as someone with a particular sort of expertise that can advise, but not direct, a patient.
But there's another part of this equation: The patient MUST be informed. If the patient is to actively participate in decision-making, then he/she must be equipped with better understanding of the issues at hand.
Proper information will not originate with the doctor. It will originate with internet-based information portals and tools (like HealthCentral) that help you understand the issues, often with far greater depth than your doctor could ever provide. The physician needs to accept this role, one of advocate, adviser, but not of being in charge, not of viewing the patient as profit-center, not as the next procedure to schedule, and not as an opponent in a power struggle.
The net result of physician-as-adviser and better-informed patient will be a happier, more satisfying, perhaps healthier and safer outcome. That, in my view, will be the key change to leads to a better doctor-patient relationship, one characterized by mutual respect. Only then can─should─you really trust your doctor.
Published On: August 12, 2008