by Wendy S. Harpham, MD, FACP
Two things are missing from the bustling conversations on health care reform jamming the Internet highway. First, where among the finger-pointing anecdotes and critical analyses of our “broken” American medical system are the stories and discussions of all that is right? Second, where is our sense of hope?
I’ve experienced American health care from an unusual, yet useful, vantage: that of a physician with chronically recurring cancer. From both sides of the stethoscope, I’ve experienced the challenges physicians face when trying to combine high-tech medicine with old-fashioned caring. And I’ve experienced the challenges patients face when trying to optimize their health (such as after a cancer diagnosis) while living as fully as possible.
Granted, I am biased. With illness forcing me to hang up my white coat in 1993, I have not experienced the full force of the pressures physicians are under today. For me, the opportunity to practice medicine was always an honor and privilege. In addition, as a patient wrestling with a type of cancer with no known cures, I’ve benefited from the progress and hope of clinical research as well as the expertise and kindness of my health care team. Modern medicine has been good to me.
Undeniably, a multitude of forces is driving physicians and patients further and further apart. Sophisticated technologies, increasing specialization, managed care and rising overhead push physicians to see more patients in less time. Our litigious culture encourages physicians to practice defensive medicine. Meanwhile patients face more treatment options and are playing an increasingly greater role in making medical decisions. They are discharged from hospitals earlier than ever, forcing these patients to assume more responsibility in their recoveries.
In our search for solutions to America’s health care crises, let’s pay some attention to all that is right. By dialing down the negative rhetoric, we can learn from stories of patients who are deeply grateful for the care they have been receiving at the hands of dedicated physicians. We also can learn from stories of clinicians who, despite the stress and strain, still derive great joy in patient care. (I suspect the reason we hear relatively few is that most good doctors are too humble—or too busy tending to their patients—to talk about the work they consider a calling, not a job.)
Medicine is an art based on science. Despite all the changes of our modern age increasing the great divide between physicians and patients, healing still begins the moment physicians use word or touch to make contact with patients. And I believe that no matter how clinical practice changes in the future, the heart of medicine will always lie deep within the clinician-patient bond.
Whatever we say or do over the coming months, let’s insist that the physician-patient bond dominates center stage of health care reform. Let’s put a high value on the time it takes clinicians to listen to their patients. By enacting measures that encourage clinicians to provide consistently expert and compassionate patient care, we set the stage for hope for me, for you, and for every American.
Wendy S. Harpham is an internal medicine physician and author of Only 10 Seconds to Care: Help and Hope for Busy Clinicians.
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{ 12 comments }
I think the doctor-patient relationship is a waste of money. The effort it takes to form a relationship isn’t worth the money.
“They go in to medicine for a reason.”
Medicine is a business and doctors practice medicine to make money.
Yes it is! They could go into law as well and make more or sales and make even more. But they chose medicine for a reason. They chose a specialty for a reason. I know several doctors who never interact with patients! Radiologists are one of them, as well as i don’t know maybe Anesthesiology. They don’t have to have any bedside manner! The funny thing is they talk all the time and are some of the best people I know!
For many physicians and nurses, myself included, medicine is a calling (and not just a “job” or “business”).
If you look beyond the high-tech machines, medicine at its heart is still about people caring for people. Like all meaningful relationships, the physician-patient bond evolves over time. And it grows stronger when based on mutual respect and understanding.
Investing in healing physician-patient bonds is time well-spent.
“Investing in healing physician-patient bonds is time well-spent.”
If medicine valued the “doctor-patient relationship,” there would be no need for urgent care clinics. Appointments wouldn’t be five minutes, and conversations on the phone would not have to go through the medical assistant who has no idea what’s going one.
Physicians use these time savers to make more money. Most rely on technology to make diagnosis. Why waste money on a relationship? Mid-levels can fill in the gaps for simple things.
Part of what makes the health care debate so contentious is that healthcare is complex and not uniform within one practice, let alone all across the country.
The path to realistic improvements — if not solutions — involves recognizing the wide variety, and then building on what is working well and eliminating (as much as possible) what is pulling the system down.
Unless your medical problem is easily curable, a strong and healing physician-patient bond is essential for both (1) getting good care (making all the right diagnoses, prescribing the best treatments, preventing and minimizing complications) AND (2) living as fully as possible (preserving self-esteem, feeling hopeful and comforted).
And in cases where the problem is easily curable, a good relationship still makes the inconvenience and stress of the problem more tolerable.
With hope, Wendy
“Unless your medical problem is easily curable, a strong and healing physician-patient bond is essential for both (1) getting good care (making all the right diagnoses, prescribing the best treatments, preventing and minimizing complications) AND (2) living as fully as possible (preserving self-esteem, feeling hopeful and comforted).”
My doctor didn’t get the memo. My complicated medical problems were mismanaged because there was never any time for a relationship. I went to the internet for diagnosis and treatment. Trying to explain my frustration and pain to the medical assistant was a waste of time. While attempting to have a discussion about my feelings of hopelessness, I was told I couldn’t get an urgnet appointment with my doctor because reimbersements were too low to leave spots available during the day.
H, you’ve hit the nail on the head with your last post: “reimbursements were too low.” This is why appointments are 5 minutes long and telephone calls go through the medical assistant: private insurance, Medicare, & Medicaid pay by service, not time spent. Your doctor can’t make a living discussing your feelings of hopelessness with you because your insurance won’t pay for it. Urgent care clinics are needed because primary care docs face long work hours & assembly-line work days cramming in as many patients as possible because reimbursement rates for primiary care are so low. This has frustrated so many PCPs that they’ve left the field, and only a tiny percentage of medical students are even considering internal medicine or family practice. It’s the shortage of primary care providers, caused by lopsided reimbursement that pays very well for procedures performed by specialists and very poorly for primary care, that’s fueling the urgent care and “minute” clinic boom. The very same insurance companies that insist on your primary care provider coordinating and making referrals for all your specialist care do not actually PAY your primary care provider for those services.
That said, there are still some primary care providers out there (like mine) who do provide excellent, unrushed care, even for patients like me with several complicated and chronic conditions. Keep looking until you find one.
“Your doctor can’t make a living discussing your feelings of hopelessness with you because your insurance won’t pay for it.”
Seems to me that medicine is a business. If a product is not cost effective, then it’s not offered-such as relationship building. This goes beyond primary care-try to get an urgent appointment with a specialist. We cling to nostagia, wanting medical care of the past when in reality, we are moving toward assembly line medicine, where providers are interchangeable.
As for those feelings of hopelessness…there are always the online support groups.
The Texas Medical Association (TMA) wanted to find out firsthand what Texas patients valued in today’s health care system, what they wanted changed and what they want or didn’t want from health system reform. The association conducted more than 15 House Calls, town-hall-style meetings, with more than 3,000 patient and doctors participating. Here is a snapshot of the findings:
What Texas patients value most is their physician, the relationship with their physician, and the ability to choose their physician. They also value the freedom to choose their own medical treatment, facility and health insurance. The other items that came to the top of their list was timely access to care, quality of care and state-of-the-art medical technology and innovation.
Patients believe that what needs to be fixed in today’s health care system is abusive health insurance business practices. Specifically, Texas patients want insurance portability, transparency and elimination of pre-existing condition clauses. They also wanted less interference in medical decisions from both government and private health insurers.
As far as health system reform goes – What we heard loud and clear from Texas patients is that didn’t want a government take-over of medicine, a single-payer system or socialized medicine. They also didn’t want health system reforms that increase costs, either by increasing the deficit or through new taxes. However, what Texas patients do want in health reform legislation is greater transparency and accountability of big health insurers, increased personal responsibility and preventive care coverage or incentives, and national medical liability reform.
So, people in Texas want lots of improvements in health care, but are unwilling to pay for them.
And the sky is still blue.
I am willing to pay for them! No matter what the cost is!
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