The close relationship between Americans and “the neighborhood doctor” is a strong piece of American mythology. People implicitly trust physicians to use their specialized training to make decisions patients may not fully understand, but always trust. At least, that’s the way things used to be. These days, the atmosphere has changed for the worse; some patients no longer trust physicians and physicians sometimes resent their patients. The question is: why?
The answer is in some ways quite complicated, but in other ways very simple. Patients have more access to medical information via the internet and do not place as much trust in their physicians. Rather than call their doctor, someone’s initial response to any kind of symptom may be to self-diagnose on a host of “medical” websites. Patients now often go into a doctor’s office the way they would walk into a furniture store, having done the research online, made a decision, and expecting the physician to give them what they’ve decided they need.
Compounding this problem are the TV pharmaceutical ads with the famous tag “ask your doctor about _________.” Patients may be unhappy when the physician won’t recommend whatever drug they saw on some commercial with smiling people running through a wheat field. The end result is that patients no longer view physicians as trusted and respected experts, but as mere workers in a service industry where the customer is always right.
Contempt for physicians is also spread by those who make money off it: personal injury lawyers and managers of “rate my doctor” physician rating websites. For years, personal injury lawyers have tried to get Americans to mistrust their doctors and, ultimately, to sue them. Their long campaign of fear and suspicion continues to gain a foothold in the American psyche. These lawyers’ interests are being augmented by an explosion of “rate my doctor” websites, where people can anonymously criticize their physician and “rate” them the same way they would a toaster or duvet cover.
In many cases, physicians simply cannot provide patients with the same type of personal care that many people remember from years past. With malpractice rates skyrocketing, compensation dropping, and physician shortages growing, most doctors are overloaded with patients. When one can only spend a few minutes with each patient, there is rarely enough time to make the patient feel like they are getting the attention they need. Though this is really the fault of a broken system that physicians are fighting to fix, the physicians are the lightning rods for patient dissatisfaction with the American healthcare system. Unfortunately, this mistrust can result in a costly lawsuit that ruins a physician’s practice or libelous online post that destroys a reputation.
Repairing the breakdown of the once sacrosanct doctor-patient relationship may require a major paradigm shift in both consumer culture and healthcare policy. In the meantime, Medical Justice protects physicians from frivolous lawsuits and Internet defamation. Our goal is to help transform healthcare into a system that benefits physicians and patients alike. And hopefully rebuild some of that broken trust.
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I applaude you for the excellent article on “Where has all the trust gone?”
CMS and private carriers now require enormous medical resources in time and money that we physicians devoted to patient care 30 years ago. EMRs and a multitude of government agencies require attention to documentation and following regulations.This requires diverting our focus that we gave to our patients in the past.
Patients want compassion, understanding, detailed physical examination and discussion of treatment options and cost from a doctor is is really listening.
Doctors now are urged by our “bosses” to concentrate on the number of patient’s seen per day and income “produced’.
As a 70 year old surgeon, I get the most reward from the 2nd paragraph above and from sharing spiritual beliefs and praying with my patients.
Healing is a spiritual calling as well as a scientific profession.
Who will lead us our of this captivity?
Glad you brought it up. The disruption of the Doctor-Patient relationship is fundamental to building the Business of Medicine (in the LARGEST sense of the term) … at the expense of Health Care, Patients and all providers … the most important of whom are Physicians. All third parties are responsible for this decline in the Doctor- Patient Relationship (DPR) and, regrettably Doctors have passively gone along … following the money. Third parties have systematically undermined the importance of the DPR and of Doctors, specifically, in the care process by paying less for “equivalent” services by generic providers, by eliminating the Value of the DPR, the Doctor, the Patient and the Human factors that are essential to Quality Health Care. By paying for specific Products, by keeping a large chunk of the available money, by failing to recognize the importance of and paying for DPR time, third parties have forced production pressure on us … to the extent that we are forced to … if we cooperate … cut corners on patient care time … at the expense of the patients and the providers. This factory, or assembly line approach often leaves patients who are unsatisfied, bewildered, confused, angry … and sometimes injured.
Regrettably, during my medical career of almost 40 years, I have watched the third parties systematically take the money and respect out of the DPR on the backs of the patients for the sake of their profits! Isn’t it time we took it back?
I’m continuing to search for like minded folks who would like help develop a Doctor-Patient Cooperative … a coalition of doctors and patients who will join forces to take it all back from the third parties. Yes, I’m talking about a new Health Care paradigm. It can be built from the ground up … and only as a non-profit. Greed has to be built out of it from the start … with caps on salaries, reasonable hourly wages and return of dividends for all members, whenever possible.
Anyone want to join me?
Buona Fortuna!
Dr. Mike
Thanks, Jeff for this good article. To me the problem is indicative of a widespread social “disease” in our country- the lack of personal responsibility. A half century ago, patients typically trusted their physicians to diagnose and render medical treatments on their behalf. Later, patients desired more personal involvement in their own health care decisions, so the doctrine of informed consent was born. The irony is that, while patients demand to be well informed of risks, benefits and alternatives of medical care, they often do NOT want to take personal responsibility for the outcomes of those same decisions. And why should they? The legal profession has convinced the public that they need not bare any responsibility for “mal-outcomes”, which is really what malpractice is all about.
It’s a sad revelation that, in the absence of real tort reform, the only way physicians will be able to survive is profile their patients, and stop doing high-risk procedures. I’m not an Ob-Gyn, but I think delivering babies is an inherently risky proposition, and any Ob who does high-risk deliveries probably needs a serious rethinking. If denial of high-risk services across all specialties means returning medicine to the 20th Century, then so be it.
The trust? We are essentially coexisting with what should be no less described than a subhuman species whose behavior defines their subhuman character and the misery it wields upon humanity. Namely, looters, moochers, *ssholes (those that speak for others without that person’s permission), bullies, tyrants (those that want control of a process but refuse to take responsibility for controlling that process…or..worse…make another party responsible for the process the tyrant controls) and sophists (those that argue to win regardless of the truth). My conservative estimate of this portion of my “fellow” Americans as subhuman species is about 30%. Even worse when the subhuman species has the political power at the top…especially since about 60% of the population often submits to authority regardless (Milgram effect).
And..yes…even amongst some of my so called “fellow” physicians I spot….at times…the subhuman character. They don’t teach character in school. And even attempts at educating these individuals …at least in my experience….does not really change their nature.
This is essentially the bane of our existence…or those that would call themselves human….that we must somehow …or..are expected to peacefully coexists with these subhuman characters.
Patients who are more and more displaying displaced aggression in combination with entitlement syndrome (mooching and looting). Professional sophists all to eager to aid them. Politicians, many trained as professional sophists, saying anything to get elected…regardless of any principle of reason.
The U.S. civil legal system…..is such that liability has little if anything to do with accountability with regards to judgments….and little if any regard for scientific probability…since the law of the land preference is for “more probable than not” …i.e. more than the toss of a coin. What would one expect in a country that is essentially a haven for sophists. California has more attorneys than all of Europe. Has anyone ever wondered why it is so difficult to get a liar convicted of perjury in this country? Why so many state regulatory agencies do little if any due diligence with regards to complainants who file malicious false reports against individuals (not only doctors…other professions are affected as well)…or…why such complainants are often not required to sign an attestation statement stating what they say is true under the penalty of perjury? Why would state regulatory agencies even have any interests in changing such a system as it is essentially beauracratic job security as the bureaucrats are paid hourly wages for their review that they do in response to the untold hours of work done by the target of false, malicious complaints. Yet, if I file a false police report….or…a false fire report…there are legal repercussions for doing so. But rarely so with the legal abuse applied against providers…in courts….in state regulatory agencies. All often defended as “the right to protect the public”….even the ones who maliciously report….even the ones who they themselves may have prior convictions of perjury, etc. but would never be discovered by a state regulatory agency because it does no/little due diligence….not to mention if it did it may impact their bureaucratic job security and/or cause more unpaid furlough days.
My advice. Disengage as much as possible. Don’t treat the subhumans. Don’t shake their hands. Don’t let your kids play with their kids till their kids grow up and prove they aren’t subhuman. Realize friendly don’t mean friend…and sometimes it is nothing more than stealth. Start with background checks. Consider psych/personality screening prior to accepting a patient, etc. Whatever. Think outside of the box.
This current situation is, at best, nothing but detente…..detente between the humans and subhumans. How long it is tolerable….or sustainable…is anyone’s guess.