Patients and Physicians: Frayed Edges
Lately I’ve been thinking a lot about the doctor/patient relationship.
When I conducted my research, I wasn’t able to observe the physicians interacting with their patients due to privacy issues and the approval I was granted by my university’s review board, but I observed the physicians as they conducted a lot of clinical work and spoke to them at length about patient care. I’ve also talked to a lot of people on an anecdotal, non-research basis about doctors, about their own experiences in and out of medical offices and hospitals, and about being patients or caring for patients.
Something’s pretty fundamentally frayed, isn’t it? Maybe even broken.
Somewhere along the line, the relationship we used to build between ourselves and our doctors, or if you’re a patient, between yourself and your patients, is gone. There are so many reasons for it - the healthcare landscape has changed dramatically. The cottage industry of physicians as it once existed is now a realm of private practice vs. bureaucratic medicine. Social and cultural capital has changed: doctors no longer hold the rarified social positions they once did. Even the hold physicians once had on the knowledge that defines their profession is changing. These are big, often scary changes that can seriously affect professional and even personal identities. They’re worth discussing.
But you know what’s also changed? Us.
Yesterday I was talking with a friend, who proposed that the disintegration of the patient/physician relationship was part of the decline of the larger social contract. How do we connect with others? How much do we connect, on an emotional or an intellectual level? Or are we becoming ever more concerned with self-reliance, individualism, and exceptionalism?
Before you jump up and yell about the amazing friends you’ve been able to meet because of the internet, or the deep connections you’ve forged thanks to technology that you otherwise might not have been able to - hang on. That’s not what I’m talking about. Yes, there are a lot of good people in this world. I’m talking about a larger issue, similar to what I discussed the past two weeks: the drawing of boundaries, and then being unable to move beyond them.
Over the past few years, I’ve had the unique experience of being able to both observe doctors and be a patient caretaker and advocate in an intense/intensive medical situation. I’m very sympathetic to physicians, because I think being a doctor is a lot harder than people often realize. People are furious at physicians, but there are so many good ones, so very many more than people realize, who struggle to focus on patients and on quality patient care, in a system that is not designed to focus on either of those things. I’m also incredibly sympathetic to patients, because being a patient in the modern healthcare system is akin to being dropped in another country with no map, no dictionary, and little to no money. Also, you’re naked.
So many people are furious at doctors. They’re angry at the way they’ve been treated by physicians, and rightly so. I myself have had some awful encounters with some awful doctors. But sometimes we forget that every profession has its share of idiots and jerks. That sometimes it’s the office you’re mad at, or the system, and you’re taking it out on your doctor who honestly has little to no control over what you’re upset about. That some doctors start out as jerks and others are ground down by medical school, or by the institutions they work for, or by something else altogether. That your doctor can only see you for 15 minutes at a time, but that’s because of a larger systemic dictate based on compensation by the providers and insurance companies and do you have any idea how expensive malpractice insurance is? That nurse practitioners and nurses are indeed wonderful but just like doctors they too can be jerks sometimes, because no one, and no profession is perfect.
That we as patients can be terrible on occasion too.
That maybe we all need to find a way to reconnect with each other.
Healthcare, like so much in our society, is a fragile ecosystem. We’ve tromped all over it, ripped out delicate relationships, layered on bureaucracy, turned it into a business - and we expect it to thrive. It can’t, not like that. Physicians should be compensated for their work. Patients should always be treated with care, in an industry designed not to confuse and bankrupt but to promote wellness and prevent illness.
We also need to encourage patients and physicians - hell, all of us, in every day life - to reconnect. To be willing to see each other as human beings, not just as “provider” and “problem list.” Your mother-of-two OB/GYN may be on her feet from 7:00 am to 7:00 pm with barely enough time to go to the bathroom, seeing 30 patients, participating in at least one surgery, filling out charts, returning patient calls, talking to insurance companies, and consoling at least one recipient of very bad news. Your patient may have dealt with a frustrated underpaid receptionist and then waited an extra 45 minutes in your waiting room immediately following a bus ride and a tense discussion with her boss regarding taking the afternoon off work for a doctor’s visit despite not having any PTO, and after the appointment she’s going home to make dinner for a husband, three kids, and a sick parent who is going through a divorce.
Technology can help us, but so can seeing beyond our own boundaries.
