The commodification of health care is destroying the doctor-patient relationship

My elderly patients miss the days when, in an emergency, they could call their family doctor at home, and they’d be cared for. Retired doctors reminisce about the “good old days” when they were in charge of their own schedules and could prescribe whatever drug or test they felt necessary based on years of experience. While there was a strong doctor-patient relationship in those bygone days, it was not necessarily an equal partnership. Patriarchal doctors expected their advice to be followed and patients generally complied because they trusted their doctors.

Patients today have lower expectations of their doctors, having never experienced a strong bond forged through generations of caregiving. Unless they need a prescription, patients seek out the help of their physician only after exhausting their own resources and well-intended advice from friends. When they do go to a doctor, it’s often at an urgent care or with someone other than their primary physician. The inability of patients to receive care from their own doctor when needed results in fragmented care — frustrating at best, dangerous at worst.

The commodification of health care is destroying the long-revered doctor-patient relationship. Doctors who joined this once-noble profession hoping to make a difference in their patients’ lives are disillusioned by endless paperwork, bureaucracy, and arguments with insurance companies that steal time away from their patients but contribute little to their actual health. Doctors don’t mind working hard when the work is meaningful. But filling out forms and scrolling through computer screens instead of focusing on their patients doesn’t contribute to a sense of purpose — it contributes to burnout. Burned out doctors not only lose compassion for their patients, but they make mistakes. They also leave medicine.

The doctor-patient relationship is complicated. During training, emotional attachment to patients is discouraged in part to protect doctors when patients inevitably become ill or die. Separation is also meant to promote objectivity and (supposedly) better patient care. A recent study by the Harvard School of Public Health, though, calls the latter rationale into question. Researchers demonstrated that female physicians had lower mortality rates and fewer hospital readmissions than their male counterparts. Researchers did not conclude that women doctors were better clinicians but rather that they were more patient-centered and reassuring than their male colleagues. This willingness to spend more time connecting with their patients actually saved lives.

The erosion of the doctor-patient relationship could be dismissed as the price of progress as healthcare facilities become more technologically savvy and rural patients are able to access doctors through telehealth. The potential health consequences of the disconnect, though, can’t be ignored. Exasperated by escalating bills and rushed appointments, patients turn away from their doctors and toward the internet — and the distance widens. Patients with chronic illnesses and high deductibles often only seek out their doctor when they’re sick enough to need hospitalization. Victims of abuse won’t disclose trauma to a doctor staring at a computer screen. When parents no longer trust their physicians, children aren’t vaccinated — a top 10 global health threat of 2019 according to the World Health Organization.

A recent study by social psychologists at Stanford University shows the true cost of the eroding doctor-patient relationship. It turns out that it actually matters to your health if you like your doctor. A doctor’s words of encouragement can improve the efficacy of drugs. Good rapport between doctor and patient isn’t just an added bonus, it’s an essential component of healing. This is something doctors have intuitively known for decades. In a 1926 speech to Harvard Medical Students, Dr. Francis Weld Peabody said: “One of the essential qualities of the physician is interest in humanity, for the secret of the care of the patient is in caring for the patient.”

There are changes that can be made on a national level to help reverse the trend of disconnect between doctor and patient. For one, every American should have access to affordable healthcare. Limits must be set on astronomical copays and deductibles that drive patients away from their doctors. Eliminating the time-consuming and expensive middlemen of bureaucracy would not only help reduce costs but also would give back precious doctor-patient time — time that could be used for health caring.

In theory, technology should free up time and allow doctors to spend more with their patients. Electronic medical records have fallen far short of this ideal, though, increasing provider frustration and further driving patients away. At a minimum, patient information stored in vast electronic files must be made more easily searchable — it should be simple to find out when a patient’s last colonoscopy was, or to compare bone densities, or retrieve all the drugs previously tried for depression. EMR systems should be able to “talk” to one another. Hospitalizations, specialist consults, and tests performed at outside facilities should be seamlessly integrated into a patient’s record. This would prevent duplication of testing and allow easy comparison of results. Doctors should not be wasting invaluable patient time fighting with inefficient and laborious EMR systems.

We don’t need to wait for political changes or technology to improve the doctor-patient relationship, though. Doctors must find a way to reconnect with the compassion that attracted them to the healing profession in the first place — before they became defeated by the business of medicine. We can smile, make eye contact and be curious about our patients. These small acts may be more important than wielding the stethoscope or prescription pad.

Patients should understand that while the credentials of their doctors are important, their connection with them is even more critical. They should seek out doctors whose opinion they trust and who listen and hear what they say. Together, doctors and patients can work to build the doctor-patient team again.

Because, as it turns out, health care actually works better when caring is a part of it.

Jen Baker-Porazinski is a family physician who blogs at Pound of Prevention.

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