BEDSIDE MANNERS

The doctor patient relationship exists only as a myth. Certainly the damaging effects of it on patients are mythic in size and scope. The urgent question to be answered is: should consumers continue their quest for a productive relationship with their physician? Or should the relationship be abandoned? Finding the answer is possible only after an in-depth examination of the interrelationship between patient and physician. But the situation cannot be reformed without a strong commitment to understand how medical care is delivered to consumers. The story of American healthcare is a saga about power. Physicians have it, patients don’t. However, power does not exist in isolation, it requires the submission of its subjects. There are very few situations in life where the powerful are so strong and the weak so defenseless as in the practice of medicine.

People who are experiencing serious illness must focus their attention and energy on healing. They should not be challenged by the very people who are providing them with care during the recovery process. Nor should they be subjected to the stress caused by the unprofessional attitudes and behaviors of clinicians. But this is what is happening. Consumers may expect physicians to conform to higher ethical standards than others. But just as in other professions physicians may fail to meet high standards. By looking at the attitudes prevalent in individual practitioners we can begin to fully appreciate what is happening at the patient level. Healthcare today is increasingly profit driven and remade in the corporate image. As hospitals trim staff and cut back on procedures patient care is transformed into a product of the mega-corporation. Cost cutting in medical treatment involves life and death decisions, which should be more important than the desire for increased profits. But millions of dollars are spent on advertising to sell healthcare instead of providing it to those who need it most. We have lost sight of the standards that were once the basis of compassion and respect for the individual.

To begin to understand what works and doesn’t work in the system, we should know more about the people working in it. For the purposes of our discussion the words patient, client and consumer are used interchangeably. Patient is the universally accepted word, standard in the health professions today. Patient has connotations of subservience and naiveté, which are consistent with the way many healthcare providers approach consumers. It is now more accurate to view physicians as consultants and technicians who specialize in the field of medicine. Modern medicine is traditional business selling the fruits of scientific endeavor and its client-patients are you and me. Unfortunately, our healthcare delivery system does not acknowledge the value of its clients who are supporting the system by creating jobs and contributing to the economy.

A popular concept in the healthcare field today is patient responsibility. This means patients accepting responsibility for their own healthcare decisions and active participation in their care. It has also come to mean accepting the emotional as well as physical consequences of those decisions.

But is this realistic? Consumers, “patients” are not the focal point of our healthcare system. The system does not revolve around us as consumers but rather catches us as on its periphery. Our view of health is validated not by ourselves but the system. As patients, consumers are allowed to take responsibility only for those decisions providers deem us capable of making. Due largely to aggressive public relations patients have been led to believe they are equal partners in the system. However, the public is not permitted to have any substantive influence or input into the system. This creates a nonproductive way of interacting between those who are giving care and those receiving care. The system itself is telling us we need a new model for healthcare. The culture field of healthcare is defined first by corporations and to a second lesser degree by the physicians who practice medicine today. The formulation and design of healthcare delivery are matched not with consumer need but driven by economics.

It is unlikely that more analysis of the doctor-patient relationship which excludes consumer input will yield new insights. If anything, this relationship has been over analyzed by psychologists. Providers continue to ignore the criticisms brought by both individual consumers and citizen watch groups. Physicians don’t believe patients understand enough about healthcare to judge it. Yet, who is more qualified to interpret quality and quantity of care than those who receive it? More fit to judge both the physical and psychological impact? Patients certainly understand how they feel during and after treatment. The only real expert on the role of the patient is the patient himself. The intersection of individual patient need and the delivery of healthcare takes place after systems are designed and implemented. The function of patient is not as partner but consumer, subject to the availability of goods and services.

It is not enough to design a medical protocol for consumers with scientific fact and fantastic technology. The underlying emotional impact of medical procedures is also an integral part of the treatment. The effects that the behavior of healthcare workers produce in their patients have long been ignored. But patients realize that the physical benefit of treatment can be offset by the emotional damage done to them by clinicians. Healthcare workers respond to patients as they have taught to. But this way of relating to patients is ineffectual because patients are individuals. Each interaction between physician and patient must express that individuality. When it doesn’t patients feel misunderstood and unimportant.

But after the emotional and intellectual frustration how do consumers regroup and redirect the course of their recovery? One significant consumer response is reflected by popular interest in the current mind-body-spirit phenomena. This search is the natural outgrowth of the need for more and better healing. But just as importantly consumers want a form of healthcare that makes room for positive, individual interaction. The search for alternative methods is as much a desire for consideration and personal respect as it is for physical healing.