Tuesday, December 7, 2010

Where Have You Gone, Marcus Welby? A Nation Turns its Lonely Eyes To You

Several posts on Eschaton this morning revolve around nasty, aloof, judgmental doctors providing unsatisfactory care. One of the symptoms of the deterioration and inadequacy of our current health care system, or what passes for it, is a deterioration in the doc-patient relationship. Nobody goes into med school thinking they'll wind up viewing patients judgmentally, as adversaries. Then, docs get beaten up, physically and mentally, in training, graduate with $150,000 or so in average debt, and see themselves as economically, legally and politically under assault in a world granting them nothing like the moral capital and economic privilege they deserve. Meanwhile, third parties pay little for services (like neurology) involving thinking rather than doing. Patient visits of greater than 7-10 minutes oft barely pay for themselves. It's little surprise that, in the absence of time spent together, patient compliance with medication regimens is low, recommendations for lifestyle changes are ignored and resented, and 'alternative' practitioners who are more 'touchy-feely' without much science on their side seen as more attractive. The docs' blog I show the lefty flag on is full of docs venting, judgmentally rather than empathetically, about non-compliant, lawsuit-happy patients refusing to take responsibility for their own health, while feeling--wait for it--entitled to medical care without paying for it. Not all docs are like that, obviously, but we've all met some like that. I'm a doc, and, when I had thyroid cancer (cured, easy one, 1989 or so), my endocrinologist refused to talk to my wife about my cancer, my prognosis or treatment. He said, in these precise words, 'I haven't the time; you're a big boy; you do it.' I found myself another (wonderful) endocrinoligist, and thought that if this happened to me, it happens that much more often to lay folk. It's important, when you have such an entirely unsatisfactory interaction with a doc, to note that, while the doc doesn't have to be an asshole, that the system militates in favor of producing them, in large numbers, and should be changed. Even some of the righty docs understand this, hate it and want to do something about it.

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