What's wrong with the doctor-patient relationship?

     It has been two months since I posted anything here, but it has not been because I have had nothing to say.  Quite the contrary!  I have the privilege of having a summer research intern - supported by my LVHN Department of Family Medicine and the LVHN network - and together we have been working on this question from a number of angles.  Stay tuned for a series of posts catching readers up with my thinking!

     Today, I'm starting with a response to the title question from a practicing physician who will remain anonymous, and who, I believe, speaks for many physicians.  This response is a reminder that many, maybe most, medical encounters are satisfactory or better for both doctors and for patients.  Maybe the number of intruding forces create a shared burden that neither doctor nor patient wants to shoulder.

    "I was thinking about this question after our (conversation) today  (actually, trying to think about this question from the perspective of practicing physicians).  My answer goes something like this…

     I like most of my patients just fine…true, it’s easier to relate to some, than to others…but, I do my best to be fair and open-minded...to try to understand where each is coming from…what it is that they struggle with…how it is that I can try my best to be of comfort and service… I try to give each person who sees me the same care and attention…sometimes, I succeed more than at other times…but, the intent to provide appropriate and thoughtful care to each of my patients is there, nevertheless…    

     What’s wrong in our relationship…?  Actually, there’s too many other people who are intruding into what used to be a private and even sacred relationship…

     -the insurance company wants to determine who I can and cannot see…and what I can and cannot offer to them…(and the government tells me that this is not the case…”you can keep your doctor”…laughable…)

     -the medical-industrial complex has come up with an extremely complex system whereby I have to match my diagnosis of record with intricate documentation parameters in order to get paid a professional’s wage…if I don’t do the documentation correctly (by their definition), payment is lowered or even refused…

     -the lawyers want to sue my _ _ _, just for dedicating my life to this art and wanting to do my best to help people and make my community just a little bit better…

     -my employer has determined how much time I can spend with each patient (“on average”) in order to see enough people and to bill enough for each encounter so that we can “keep the lights on”…since when did business people become in charge of how I should best spend my time?!?

     -the general public thinks that I have much more money from this than I actually do…(not that I entered medicine to get wealthy…I did not…what I mind is the projection that some place on me as having more money and feeling more entitled than I actually do…most of my physician colleagues are like me as well…more interested in helping and serving than in getting wealthy in the process…)

     -Various medical supply companies are always sending me official looking documentation trying to get me to sign for some medical trinket that my patient doesn’t really need…sometimes the patient gets mad at me for declining such trinkets…

     So, I think that my relationship with patients is just fine…not sure that I need a group to tell me that…what I need is to have all of the other people and processes that interfere with my patient work to get the f  out of our way so that my patient and I can do the work that we need to do together."