Tackling the crisis in medicine

"Doctors Tell All" is the title of Meghan O'Rourke's November 2014 article in The Atlantic. The core message of the article is "...the patient-doctor relationship is still the heart of medicine. And it has eroded terribly." In the article she explains why she believes this is true.

We all want an empathetic physician who is highly trained in the science of medicine who will listen to who we are relative to why we don't feel well. The science of medicine is relatively easy to learn, and can be tested by exams to document that the medical student has learned what should be learned in order to practice effectively.

However, what is being discussed in O'Rourke's article is the "art" of medicine, a much more difficult skill to teach and to test for competency, and to provide research data proving the therapeutic efficacy in patients lucky enough to be under the care of a doctor skilled in both the science and art of medicine. Having spent four decades teaching and practicing medicine, I have seen the "erosion" O'Rourke writes about both in myself, students and doctors in training.

What is refreshing about O'Rourke's article is her empathy for doctors who are now disillusioned ("... in a 2012 survey, nearly 8 out of 10 physicians are somewhat pessimistic or very pessimistic about the future of the medical profession"), and I agree with her that the main issue is lack of time. ("doctors spend just 12 to 17 percent of their day with patients"). The same problem exists for nurses, respiratory therapists, and others. The current joke is true. "How much time does it take for a nurse to hang an I.V.? Answer: 25 minutes. Three minutes to hang the I.V. and 22 minutes to 'document' that it was hung."

Machines have replaced the physical finding skills of the physician and removed the time and intimate contact that goes with it. I admit that machines are usually more accurate and more objective than a stethoscope, as one example. However, the stethoscope is still useful. New graduates have little skill with a stethoscope because ECHO cardiograms, CT scans and other technical and noninvasive marvels have made the stethoscope nearly obsolete. I taught students that one of the best ways to show empathy during an exam of the chest or abdomen is to always touch the patient where it hurts. The stethoscope is a way to safely do that.

The Electron Medical Record (EMR) has worsened the lack of time problem. It has done nothing to free up the physician's time for more patient contact. It has filled histories and physicals along with progress notes with "cut and paste" information that rarely tells the patient's story. Progress notes that once might have been at most a page long are now five pages, filled mostly with repetitive data and a long list of diagnoses that have nothing to do with the current problem.

Hospitals Information Technology departments now are an enormous slice of a hospital's budget and exist almost exclusively to render reports to government agencies and insurance companies so they can discipline errant behavior or deny payment. The never-ending surveys that feed off these reports (e.g. "The Joint Commission" and others) cannot show any research data that proves that the decades of their surveys of hospitals has improved patient morbidity or mortality.

O'Rourke quotes Sandeep Jauper, who offers another cause for the erosion of the relationship between patient and doctor, that being the physician's current view of himself. He is no longer a "pillar of any community but instead is a technician on an assembly line, a pawn on a money making scheme for hospital administrators."

Now, we can add a new dimension to the erosive climate ahead of all of us, regardless of which side of the stethoscope we find ourselves. The governmental architects of this morass knowingly lied to all of us in order impose their will. The lying being justified because we are considered too stupid to realize what is good for us. That level of perfidy is unconscionable and there should be hell to pay for it.

So what is the solution? I believe that one of the ways to heal this erosion is for physicians to recognize that the anger we may have about the system is justifiable, but must not be passive/aggressively directed at patients. We must constantly remind ourselves that the act of dealing with another's health is a sacred trust and the patients will more likely get better if they are under the care of a physician who sits down at the bedside, takes the patient's hand and really listens. This effort called "Health Care," after all is said and done, is about caring and is central to the effort.

Dick Sheldon, MD, is a Coeur d'Alene resident.