A patient Tweets a play-by-play account of a physician’s words and actions during an office visit, documenting his every move. Does the patient give up privacy rights by doing so? Perhaps. But the bigger overall concern is that their patient/doctor relationship has become adversarial.

The Tweeting itself became the subject of on on-line debate. Though most patients don’t feel this way, comments from some participants suggest that being suspicious or distrusting of one’s physician may be more common than expected. Or were we just not paying attention.

People become suspicious of that which is not transparent to them, even if there’s nothing covert going on. For example, someone in the debate objected that doctors are allowed all manner of notes and witnesses, but a patient undergoing surgery is not allowed to have a spouse or loved one in the O.R to guard the unconscious patient, to ensure that the correct procedure is performed and that no unauthorized recordings or viewings take place while the patient is under anesthesia.

Surgeons are happy to explain the safeguards employed to ensure that the correct procedure is performed. In the past, it never seemed necessary to explain why the layman was not welcome in the O.R. These days, some suggest that it is because surgeons have something to hide. The policy is not in place to cover anything up, but for the safety of both patient and layman observer. For example, if the “witness” should faint from the graphic reality, suddenly there is an extra patient to tend to, distracting the team’s focus from the surgery at hand. That’s just one of the many reasons why laymen are not allowed in an O.R. Nothing at all untoward going on. Just the opposite, you see.

On the other side of things, greedy lawyers and misguided patients have forced doctors to exercise excessive caution. Health care professionals now spend an enormous amount of time, expense and energy documenting even the smallest medically unimportant detail. They have been forced to order tests which are not germane to diagnosis, to call in specialists to confirm diagnosis even when the cause of the malady is clear… All of these measures are taken in hopes of being able to successfully defend against a lawsuit. Statistics show that at least 75% of all medical malpractice suits are unwarranted. Of the remaining 25%, some are not truly malpractice, but simply a less than ideal outcome. Regardless, the doctor still has to take all that time, trouble and expense to defend his every thought, choice and action. When he’s proven innocent of the allegations, he will receive no compensation for the costs of that defense, and the cost of his insurance premium may increase.

In the overall picture, there’s another expense – one we all pay: While the doctor and staff are busy preparing that defense, other patients are not being seen and cared for. Frivolous lawsuits add another burden to a health care system that is already overworked most of the time.

The doctor has come to fear that the patient may sue. Some patients have even threatened to sue unless the doctor prescribes unnecessary drugs. The trust has become strained on the physician’s side as well.
When the patient is convinced that the physician is the enemy, someone to guard against, the relationship is clearly dysfunctional. That, too, becomes a Patient Safety issue. This is just one of the reasons why Tort Reform is so foundational to functional health care reform.

Both doctor and patient must return to feeling comfortable in trusting one another. The doctor cannot diagnose and treat accurately without clear and candid communications. Moreover, the patient’s focus should be on getting well, rather than Tweeting potential basis for a lawsuit to the world. Tort Reforms would go a long ways towards bringing doctors and patients back to the sort of relationship which works best for everyone.