Is Medicine Becoming Doctor vs. Patient?

 

Patient waiting time is often explained as a story of doctors versus patients. A Kaiser News Article on the PBS page is a good example:

“Dr. Richard J. Baron, president of the American Board of Internal Medicine, said that patients and physicians often wrangle over control of that visit – a “struggle for control” over the allocation of time.”

What is it about the doctor visit that allows it to be portrayed as a zero sum game between doctor and patient?

A similar feeling of competition between doctor and patient is examined by Dr. Abigail Zuger  in a recent New York Times piece  She writes, “Medicine is full of competing agendas. Even at the best of times, the match between the doctor’s and the patient’s is less than perfect, sometimes egregiously so.”

Dr. Zuger makes this point in the context of running late, and how running late affects the practice:

“So when there is enough work to last till midnight, my agenda shifts, and not so subtly. Everyone can tell when I begin to speed. Every visit is pared down to the essentials. All optional and cosmetic issues are postponed, including most toenail problems and all paperwork. Chatting is minimized.”

This is a formula that will lead to doctor burnout and frustrated patients who have been waiting, often for a long time, to see their doctor.

But maybe the doctor vs. patient narrative is really a stand in for something else.  A recent Health Affairs article “The Medical Profession’s Future: A Struggle Between Caring For Patients And Bottom-Line Pressures” speculates on what effect the increased demands on documentation will have the future of the medical profession, a question we addressed in a previous post.  Phillip Miller writes “Is this enough to pose a threat to the existence of the medical profession? Not in and of itself. But to the requirements to document quality must be added a cascading number of bureaucratic duties of various types that physicians must perform apart from the clinical services they provide to patients.”

He concludes by rhetorically asking:

“The question is, Will medicine remain a calling with patient care at its heart or become a mere occupation, characterized by bureaucracy and a focus on the bottom line? The former is to be hoped for, but given current trends, the latter should be anticipated.”

Perhaps a greater danger exists in the present moment of reform.  As doctors face frustrations with documentations and new duties, and patients experience their frustrations with ever confusing systems of care, perhaps the animosity toward the system becomes an animosity toward a person.  The abstract anger at a system becomes the concrete anger at that system’s representative in a room- the doctor.

In short there is a danger that the doctor and the patient will represent for each other their fears and frustrations with a system they cannot control.  Perhaps the reason we tell the stories of doctor vs. patient is because they are easier to understand than the complicated stories of health care that dictate the parameters of the doctor patient encounter.

In order for the doctor and patient to see their common interest, they need a perspective that is larger than the day-to-day frustrations in the practice.  This perspective is something that as a union we hope to provide.