Physicians should go back to basics with their patients

Commentary. By Eric Anderson, MD, AMNews contributor. Oct. 7, 2002.

At a time when there's never been more known about health and disease, Americans have never seemed more confused about what they want from their doctors. It's a bit like the anomaly of what people expect from their politicians: more services but less taxes.

Although we find bumper stickers that say, "I love my country; it's my government I hate," we don't quite get that love-hate connection with our patients. But in my opinion, the doctor-patient nurturing relationship, developed over the centuries, is basically gone.

Oh, there are surely small towns in Iowa, coastal villages in Maine and remote settlements in Texas -- and elsewhere -- where doctors still bleed for their patients, but in general, in this new century we've practically bled out. It's a shame we've lost what was always so precious to the sick: caring, compassionate, personal physicians who knew their patients well and were full of the milk of human kindness. That the milk would appear to have gone sour is only partly the doctor's fault; there are two persons connected to a stethoscope, one at each end.

For our part, we permitted the insurance companies to intrude into what is essentially a very private relationship and, surprisingly for a group considered to be so entrepreneurial, we rolled over when managed care became the New Deal. And we allowed, even caused, medical care to become a business. Big business.

But I blame our patients more, only partly because, like many people, I don't always care to look in mirrors. I blame patients because they are so ready these days to believe the worst of us collectively. Maybe they are that way because they are bombarded by the media. They read magazines that exhort them to take charge at the doctor's office, or articles that tell how to haggle with doctors over fees.

And they ponder cartoons in glossy magazines that show, for example, two couples driving around glitzy winter resorts in Florida in a flashy convertible. And as they pass all the beautiful people, one wife says brightly to the other: "Look at all those people! Now my David's a doctor, and so is your Richard, but how can those other people afford all this?"

If we want to win back patient trust, we have to go back to basics. We need to give patients what they want. And what they want is no mystery. Patients have been telling us what they want for years all through the long decline of our association with them.

It goes without saying that they expect accurate diagnosis and proper treatment; they usually get that in a high-tech, somewhat offhand way.

What else they want is less tangible but just as easily understood.

It's what many of my doctor friends acknowledge they want when they are patients. They want:

To be seen on time. Sure we have emergencies, but that's not the usual reason for running late. We have to get better organized.
To be acknowledged as a person. Patients who have made several visits to a doctor, even a subspecialist, feel that the doctor should surely know something about them by that time and should be able to find something, anything, to say to show doctors don't just see them as numbers.
To be listened to. Yes, doctors have their agendas, but patients do, too. The visit, like a good marriage, has to be a compromise. Patients claim they wouldn't doorknob the doctor if the doctor didn't try to open the door and escape before they, the patients, were finished. This is a hard one. I've not had many patients, especially elderly ones, who could come to the point quickly and prioritize their problems objectively.
To be reassured. Part of the value of any visit is to be told the condition is not serious, not cancer -- if indeed the patient is worried about those issues, and usually patients are.
To be advised later with test results even if the tests are negative. Every chart, in these days of answering machines, should have a notation saying whether it's OK by the patient to leave tests results on the machine. If yes, that solves the doctor's problem of reporting negative tests.
To be discharged from an acute problem when it's over yet, paradoxically, to have a distant future appointment to play it safe. They've read that a personal physician offers the value of longitudinal care, so they are surprised when, unlike their dentist, the doctor dismisses them from care as if from his or her point of view, they don't need to come back until the next century. They don't like that. They want the security blanket of a check-up visit sometime next year.

They are tomorrow's patients, but they want to be treated like yesterday's. And who can blame them? Yesterday was a lovely day.

Dr. Anderson is a family physician in a 300-doctor group in San Diego.

OPINION

Physicians should go back to basics with their patients

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