Do you have the right to expect your doctor to treat you as a individual human being, rather than as a statistic, a set of symptoms or as a monetary gain? I myself have often been made to feel as though I were on an assembly line conveyor belt with the doctor checking his watch ready to push a button to move me to the next station for bloodwork or an X-ray. We all need to feel that what we have to say is important and worth listening to and that we ourselves are important. Illness is frightening because it opens up all sorts of possibilities for an uncertain future. Our fears need to be addressed and alleviated, rather than exacerbated by unanswered questions and the indifference of an over-scheduled physician.
"Something is happening to American health care. It's been happening for some time now. Right before our eyes. As national attention is focused on containing spiraling health care costs, the hidden price of that containment eats away at the very heart of our medical delivery system. The price of containment may be the doctor/patient relationship, unless the danger of its erosion is recognized and certain misguided attempts at reform are redirected. In more than fifty years of medical practice, I have been dismayed at the recent escalating tragic conflict between medical and financial priorities." (25)
Dr Jeffrey M. Thurston goes on to state, "As President and Chairman of the Department of Surgery at Baylor College of Medicine for many years, I have supervised the training of thousands of physicians. The disparate goals of physicians who were trained to put the patients' welfare first and those of the profit-driven, insurance-owned medical corporations are rapidly disillusioning physicians and patients alike. Increasingly, the sanctity of life is being subordinated to Mammon, and medical decisions are being dictated by those unqualified to do so. The patients' choices are being wrested, and the physicians' authority is being expropriatedto the detriment of all....So-called managed care, as it is already evolving even without government intervention, is severely altering the doctor/patient relationship, transforming what can be a very special personal interaction into a business transaction. It is usurping the doctor's decision-making power, forcing diagnostic and treatment decisions to be made by a third party whose central concern is cost. Costnot the patient's welfare." (26)
"Many of us entered medicine out of deep altruism," says Dr. David Hilfiker, "wanting to be of service, only to discover that the daily crush of dozens of sick and needy souls left us exhausted. Under such circumstances, we found ways to detach ourselves from the emotional turmoil of the sick. We may have become physicians desiring to enter deeply into our patients' lives, but we soon discovered that the long line of patients waiting to be seen encouraged us to be more efficient and cost-effective. We discovered that the economic pressure to see 30 or more patients a day did not allow for the kinds of relationships we had envisioned." (27)
Physicians can charge more money for procedures, such as suturing a wound or ordering bloodwork, than they can for just talking or listening to a patient; the interaction is cut short so that the doctor can move on to a more profitable patient. The first patient feels shortchanged and may not even have had a chance to inform the doctor of pertinent issues that could affect his future health. His experience could very well discourage him from seeking medical assistance when next needed. (28)
"The blight of burnout is so pervasive in the health care system that everyone expects it to happen," says Dr. Adam Patch. "Most health care professionals I have met tell me that burnout damages their personal as well as their professional lives....The first cause is poor communication. The joys of relationships are lost if a physician can spend only short periods of time with patients; gone is the thrill of intimacy. If physicians could really delve into their patients' lives and take time to understand the whole person, all-important lifestyle issues could be addressed. Medications are often substitutes for what the patient really needs. Longer visits make physicians' and patients' lives more real, because shared time is a key ingredient in friendship. Without this kind of friendship, 'bedside manner' can feel impersonal and superficial. An imbalance between work and personal time can also foster burnout....A third cause is that medicine operates as a business, thereby inviting all the stresses of a business....Any health care professional who entered medicine to serve humanity is pained every day by its business aspects. Health care is denied to the poor and limited to many others....Healers wear down as their dreams of serving humankind become compromised....Anxiety about malpractice suits also breeds blame and inhibits intuition, creativity and scientific investigation. (29)
"The greatest shock I experienced in medical school came during discussions with teachers about the doctor/patient relationship. The overwhelming majority emphasized the importance of professional distance. This meant maintaining a scientific detachment and dealing with patients as if they were experiments in a laboratory. The 'distance ethic' was extended to the wards where doctors described patients as diseases, lab values, signs, symptoms, or treatments. I was amazed that a group of doctors 'on rounds' could hover around the bed of a human being, staring at, poking, or even undressing him or her with little more consideration than was given to dogs in the physiology lab....None of these conditions improved during my internship; in fact, they grew worse. Under intense time pressures, the human component was confined to simple answers for extremely complex questions....as I discovered this cancer in my profession, I started to wonder what it was doing to the patients. So I asked them. I heard anger, fear and despair flow out in a torrent of frustration. Rarely did I see their eyes sparkle for their doctors. If they did light up, it was more often for the professional's reputation than for his or her compassion....After more than twenty years of searching for one, I still have not found a happy hospital setting. (30)
"Medicine, you are blowing it! Bedside manner has nothing to do with information about the patient! Bedside manner is the unabashed projection of love, humor, empathy, tenderness and compassion for the patient. Scientific brilliance is an important tool, but it is not the magic inherent in healing....Doctors should never buy into the lie of professional distance....Every human being has some kind of impact on another....Don't we want that in the doctor/patient relationship?" (31)