A growing culture of hostile dependency toward doctors

An interesting phenomenon is occurring in media circles these days.  No doubt others have seen it, too.

Lately, doctors are being schooled by the media.

From how to learn empathy, to improving communication with patients, the breadth and depth of what we should do for our patients is endless.  Why, some even have our own colleague experts tell us how we should really do things.

These efforts, while probably well-intentioned, are patronizing.  Do doctors tell journalists how to write or what to print?

Why are doctors seeing these mainstream media efforts?  Is it because most doctors are really incapable of the ability to listen and communicate with our patients?  Is it because we must keep a stiff upper lip for what’s coming in 2014?   Or is this not-so-subliminal agenda of social engineering underway for some other reason?

It goes without saying that all of us should communicate better.  (Think how many wars or family fights we could have avoided if we had, for instance.)  And every doctor should turn their head away from computer screens and toward their patients, hold the patient’s hands, look into their eyes, listen to their concerns, put ourselves in their place, do a thorough physical exam, have constant empathy and insight, read back medications, write out written instructions in 5th grade English, escort our patients back to the waiting room, or utilize highly skilled and educated assistants with all of these tasks, too.

But the reality is this: time and ancillary resources are limited these days for doctors.  Helpers cost money.   Productivity must occur before new helpers are hired.  More people than ever are entering health care thanks to intense marketing campaigns and new mandates for care.  And there are so many doctors with only so many minutes in the day.

So doctors have to triage.  Sickest first.  We move as fast as we can to remain productive, because that’s what’s really valued in healthcare these days.  So is patient loyalty because that’s what keeps them coming back.  But in the process of growing loyalty, we increasingly have to document everything or other payers think it doesn’t happen.  So we type.  And click.  And type.   And click.   And print.  To get paid.  Talk about a communication and empathy buzzkill.

Yet for those looking in, we must communicate better.  “Listen to our experts!” they proclaim.

Medicine was once considered a place where patients could confide in their doctors about their most intimate concerns and doctors had time to listen. Notes were one- or two-line jots in a chart.   We’d spend the extra time because we were valued for our skills and for our knowledge and there was more to it than just pay.  We had skin in the game. We got paid in chickens.  We knew our patients.  Back then, seven-minute appointments didn’t exist.

Now, doctors are cultivated as shift workers.  Patients have Google.  Everyone has information at their fingertips.  Our new story line has become there are no limits to what patients can have in health care.  Perfect data.  Perfect health care access.  Error-free health care with perfect delivery.  Perfect communicating doctors.  Always.  We’re building our medical Utopia.

But this effort to school doctors on our path to Nirvana has a serious downside for health care workers on the front lines.

As I’ve said before, there’s a growing culture of hostile dependency that continues to grow toward doctors  these days.  The theme is like an adolescent who realizes his parents have feet of clay.  He comes out of his childhood bubble and realizes his parents have failures and limitations because they are human beings.  This results in the adolescent feeling unsafe, unprotected and vulnerable.  Since this is not a pleasant feeling, narcissistic rage is triggered toward the people he needs and depends on the most.  None of this occurs at a conscious level.  Most of us understand this behavior simply as “adolescent rebellion,” not understanding the powerful issues at play.  So when we spotlight one side of what doctors should do for patients, be it improve communication or empathy (or whatever) without acknowledging the realities health care workers face like looming staffing shortages and pay cuts, we risk fanning the flames of narcissistic rage against the very caregivers whom we depend on the most - the very caregivers who are striving to communicate, do more with less, check boxes while still looking in the patient’s eyes, meet productivity ratios, all while working in a highly litigious environment.

So be careful.  Maybe we should school doctors less and value them more.

Who knows?  Such a move might make things better for everyone in the long run.

Wes Fisher is a cardiologist who blogs at Dr. Wes.

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