“The practice of medicine is an art, not a trade; a calling, not a business; a calling in which your heart will be exercised equally with your head.”
– Sir William Osler
One of the most sacred and intimate relationships is that which exists between patient and physician. A patient shares feelings and fears as he traverses the path of illness or chronic disease. As roadblocks in health emerge, a patient looks to his physician for encouragement and guidance. This is especially important to the older patient since, with advancing age, comes the potential increase in health-related issues.
Open communication between physician and patient requires a level of trust that must be in place. This can only be fostered if a patient has confidence in his/her doctor’s medical knowledge and also feels that his doctor has his welfare as the top priority. A patient should feel that his voice is being heard, that his story is being heard. He should not feel that he is being “talked down to” in an authoritarian manner, but rather the physician makes an effort to explain fully and completely in a tone that is not condescending. A patient expects the truth to be given as it relates to the medical situation, but it should be delivered in a manner that does not provoke fear or anxiety. The opportunity to ask questions of the physician is always present and encouraged, and responses are given in a manner that the patient can grasp. Decision-making is always shared between patient and physician, where both sides are given ample audience. As an advocate for his patient, the physician is always seeking out the best possible line of care for the patient, whether it be within his realm or that of other specialty areas. In its purest sense, the doctor-patient relationship is a partnership forged by respect, compassionate care, and commitment; if forged properly, it will endure the highs and lows in life’s journey.
The world of medicine has certainly evolved from when Sir William Osler practiced and instructed future physicians. The corporate world has overtaken how medicine is practiced. Smaller independent practices that provided autonomy for the physician have practically disappeared. Now, physicians are employees of health care corporations led by administrators who usually have no background whatsoever in medicine. Physicians and nurses find themselves overworked and undervalued. Administrators generally treat these trained and skilled professionals as a means to an end — profit for the corporation and establishment of a brand- name. In what is referred to today as “patient-centered” medicine, those who stand face-to-face with patients every day have very little input on how the practice of medicine is to be carried out. They may have a “seat at the table,” but their recommendations, their voices, often fall upon deaf ears.
Increases in governmental regulation, restrictions additionally imposed by health insurance corporations, and mandates of health care systems have all pushed physician burnout and suicide rates to an all-time high. Meditation may somewhat help to lessen stress, but it certainly is not a long- term solution. The major burden of responsibility should be placed on corporate medicine’s shoulders. Many physicians feel that they are watching their lifeblood drain out; their love of medicine, which initially drew them into the field, is evaporating. The root causes of this critical situation are, seemingly, an ever-increasing workload, an inefficient electronic health record system, high-stress levels innate to the job, and the loss of autonomy in the manner in which physicians practice medicine. All have had a deleterious effect, all forming the “perfect storm.”
“The practice of medicine is an art, not a trade; a calling, not a business; a calling in which your heart will be exercised equally with your head.” The introductory statement bears repeating. As a patient standing on the sidelines, I have seen medicine’s practice be transformed into a business rather than a calling for some of our most talented and dedicated individuals. An area hit hard is in primary care. During the pandemic, physicians and nurses have served on the frontlines, advising patients and representing some semblance of stability in health care. Their service should not go unnoticed.
As mentioned earlier, patients and physicians form invaluable partnerships. When factors affect one side of the equation, the other side will inevitably be affected. Burnout, physicians leaving the profession, physician suicide all have led to a shortage of physicians. This will only get worse unless action is taken. More and more, physicians are being replaced with mid-level professionals who lack the years of education and hands-on experience possessed by our medical doctors.
Patients do notice. Patients do care. Doctors, the time has come to gather collectively and communicate with each other so that your voices may be heard. Your professional organizations, for the most part, have failed you. When the burdens of the pandemic have been lifted, the time for re-evaluation will have arrived. Present a united front for beneficial change in the profession you once loved. It is still there waiting for you. We, as patients, will stand with you.
Michele Luckenbaugh is a patient advocate.
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