What is it about today’s medical care system that isn’t working?

The first thing we need to do is analyze what’s broken.

Let’s approach this problem as if it were a patient in our office. It’s our job to deliver a diagnosis based on the patient’s problem.

That’s easy; we’re doctors, after all.

“So, what seems to be the problem today, Mrs. Smith?  How can I help you?”

“Well, it seems that no matter how hard I try, I can’t make progress. I want to get better, feel better, and do better. I really do. But somehow, it never works out. I don’t know what to do first, or second, or third. And, when I try something that I think will help, it lasts an hour, an afternoon, or maybe a day. But then, I’m right back to where I started.”

Does this sound familiar?

It’s the problem of searching. Of struggle. Of stirring the pot but not having the recipe.

Let’s dig in a bit and ask ourselves an important question: What is it about today’s medical care system that isn’t working?

And, let’s agree that pointing fingers at the systems of pharmaceutical companies, government, and the insurance companies doesn’t solve anything.

Let’s go deeper to see the inner workings. Let’s get out our stethoscopes and really listen to that heartbeat.

The problem starts at the door to the exam rooms.

Before opening the door, what do you usually feel?

  • Is it anxiety?
  • Pressure to be done before you begin?
  • Frustration with the patient who doesn’t seem to get better?
  • Confusion that you don’t have a plan?

Next time, before you open that door, stop and listen. Listen to the thought loop that’s running constantly in your head, guiding you every day.

I have heard some doctors say, “This job would be okay if it weren’t for the patients.”


The truth is that our jobs wouldn’t exist if it weren’t for the patients.

Maybe the doctor who feels that way should be in hospital administration, pathology or radiology.

Maybe they should study accounting.

For the rest of us, let’s begin by breaking down how to address a patient’s problem.

Before you walk through the door, ask yourself:

  • Who is this patient and what is her concern today?
  • If you’ve seen the patient before, has her previous concern been addressed and is it better?
  • If the patient is new to you, what is her biggest fear as she sits on the other side of the door?
  • What do you need to know to greet her and help her feel relaxed?

Rather than thinking:  Uh oh, the medicine that I gave Mrs. Smith for her problem last time did not seem to help. She is still complaining about the same problem. What now?

Maybe you should break it down:

  • First, did Mrs. Smith actually use the medicine you recommended, or see the specialist you suggested, or follow your plan to reduce her stress/weight/inflammation?
  • Did she follow your instructions to the letter?
  • Or, did she use the medicine you prescribed only once or twice a day, instead of four times a day, as you had hoped?
  • Did she stop taking the medicine because she believed it wasn’t working?
  • Did it make her feel nauseous or sick?
  • Maybe she couldn’t afford to get all the medicine?
  • Maybe she had to take care of her father in hospice and couldn’t get to the drug store across town for her refill?
  • Maybe her child has been sick?
  • Maybe she is stretched beyond measure to go to work, take care of her child, and has only a few minutes a day to pay attention to her own health?

The truth is, we can never truly know what’s going on with our patients until we break it down. Piece by piece. Start with that.

Instead of getting defensive because the patient’s problem is still there, try to use compassion to see beyond your frustrations.

Because the problem isn’t about you or the patient — the problem is just the problem.

It doesn’t mean the patient is any less of a person or that you are any less of a doctor.  Maybe the fact that it hasn’t worked can help you find the next step.

So, before you open the exam room door, take a deep breath.

Send loving, healing thoughts to your patient as you enter the room and receive their look of welcome.

After all, you two are a team. You and the patient. And each encounter you share is really about taking steps, together.

Starla Fitch is an ophthalmologist who blogs at Love Medicine Again.


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  • momtwoboys

    The cost. Even with insurance I had surgery that completely drained my savings.

  • http://www.waynecaswell.com Wayne Caswell

    I think Dr. Fitch is addressing the Wrong Problem. Maybe that’s a failing of our medical schools that teach diagnosis and disease management, and our payment system that profits from seeing patients as returning customers and works to keep them (paying) with a fee-for-service model that treats symptoms.

    Her statement, “Our job wouldn’t exist if it weren’t for the patients,” supports my argument. It typifies our Sick care system and seems far removed from a Health care system.

    Apparently, new doctors aren’t taught enough about nutrition, prevention, public health, integrative medicine, and the real objective of a Health care system — to promote a healthy population and avoid the need for medical care as much as possible.

    But I don’t blame the docs. I’m with Steven Brill, author of TIME Magazine’s 38-page report, “A Bitter Pill: Why High Medical Bills are Killing Us.” He blames a Medical industrial complex (hospitals, insurers, drug companies, testing companies, and equipment providers) that doesn’t want to stop making $2.7 trillion/year from illness & injury and spends twice as much on lobbying as the Military industrial complex.

    Unfortunately, Brill’s article is now behind a subscriber paywall, but you can see a summary and a video intro by the author at http://www.mhealthtalk.com/2013/02/why-high-medical-bills-are-killing-us/.

    • rbthe4th2

      Oh my yes! I have ONE doctor that knows about nutrition and how to use it like a drug. I know more than some RD’s and the like. Give us a practical test, and it would be obvious.
      This article did point out some excellent items here, first and foremost, stop blaming the patient. If the diagnosis or treatment wasn’t right in the first place, the reason we come back is so you can take another stab at it. We are there because we want to feel better.
      The other is that each doctor needs to listen to the patient, not to other doctors. I’ve seen well too many pass off “mental” issues for hard to diagnose/rare issues because of “blow off” syndrome.

  • JPedersenB

    Another question, “What if there is no reason for this visit other than my office protocol requiring patients to have an office visit every 6 mo., every 3 mo., etc., regardless of the need?”

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