Dear doctor, we’ve lost our faith in medicine

[Dave C]

I found this article in the NY Times. Interesting in regards how the drug and Insurance industries are dictating patient care.



Dear doctor, we’ve lost our faith in medicine
What can be done to repair the crumbling doctor-patient relationship?


By Tara Parker-Pope


A growing chorus of discontent suggests that the once-revered doctor-patient relationship is on the rocks.
The relationship is the cornerstone of the medical system — nobody can be helped if doctors and patients aren’t getting along. But increasingly, research and anecdotal reports suggest that many patients don’t trust doctors.
About one in four patients feel that their physicians sometimes expose them to unnecessary risk, according to data from a Johns Hopkins study published this year in the journal Medicine. And two recent studies show that whether patients trust a doctor strongly influences whether they take their medication.

The distrust and animosity between doctors and patients has shown up in a variety of places. In bookstores, there is now a genre of “what your doctor won’t tell you” books promising previously withheld information on everything from weight loss to heart disease.
The Internet is bristling with frustrated comments from patients. On The New York Times’s Well blog recently, a reader named Tom echoed the concerns of many about doctors. “I, as patient, say stop acting like you know everything,” he wrote. “Admit it, and we patients may stop distrusting your quick off-the-line, glib diagnosis.”
Doctors say they are not surprised. “It’s been striking to me since I went into practice how unhappy patients are and, frankly, how mistreated patients are,” said Dr. Sandeep Jauhar, director of the heart failure program at Long Island Jewish Medical Center and an occasional contributor to Science Times.
He recounted a conversation he had last week with a patient who had been transferred to his hospital. “I said, ‘So why are you here?’ He said: ‘I have no idea. They just transferred me.’
“Nobody is talking to the patients,” Dr. Jauhar went on. “Everyone is so rushed. I don’t think the doctors are bad people — they are just working in a broken system.”

The reasons for all this frustration are complex. Doctors, facing declining reimbursements and higher costs, have only minutes to spend with each patient. News reports about medical errors and drug industry influence have increased patients’ distrust. And the rise of direct-to-consumer drug advertising and medical Web sites have taught patients to research their own medical issues and made them more skeptical and inquisitive.
“Doctors used to be the only source for information on medical problems and what to do, but now our knowledge is demystified,” said Dr. Robert Lamberts, an internal medicine physician and medical blogger in Augusta, Ga. “When patients come in with preconceived ideas about what we should do, they do get perturbed at us for not listening. I do my best to explain why I do what I do, but some people are not satisfied until we do what they want.”
Others say the problem also stems from a grueling training system that removes doctors from the world patients live in.
“By the time you’re done with your training, you feel, in many ways, that you are as far as you could possibly be from the very people you’ve set out to help,” said Dr. Pauline Chen, most recently a liver transplant surgeon at the University of California, Los Angeles, and the author of “Final Exam: A Surgeon’s Reflections on Mortality” (Knopf, 2007). “We don’t even talk the same language anymore.”
Dr. David H. Newman, an emergency room physician at St. Luke’s-Roosevelt Hospital Center in Manhattan, says there is a disconnect between the way doctors and patients view medicine. Doctors are trained to diagnose disease and treat it, he said, while “patients are interested in being tended to and being listened to and being well.”
Dr. Newman, author of the new book “Hippocrates’ Shadow: Secrets from the House of Medicine” (Scribner), says studies of the placebo effect suggest that Hippocrates was right when he claimed that faith in physicians can help healing. “It adds misery and suffering to any condition to not have a source of care that you trust,” Dr. Newman said.
But these doctors say the situation is not hopeless. Patients who don’t trust their doctor should look for a new one, but they may be able to improve existing relationships by being more open and communicative.
Go to a doctor’s visit with written questions so you don’t forget to ask what’s important to you. If a doctor starts to rush out of the room, stop him or her by saying, “Doctor, I still have some questions.” Patients who are open with their doctors about their feelings and fears will often get the same level of openness in return.
“All of us, the patients and the doctors, ultimately want the same thing,” Dr. Chen said. “But we see ourselves on opposite sides of a divide. There is this sense that we’re facing off with each other and we’re not working together. It’s a tragedy.”

[Grumpy]

Lawyers are also to blame and the high malpractice insurance. The State also has a big hand in it too-I think the doctors are 3rd in line.....

[Toebin]

There definitely is a disconnect in the system but I also think many patients expect the docs to have THE answer on their care right off the bat.

It takes time for a skilled practitioner to diagnose, and they are only as good as the information they are given as well. Patients often are not completely up front with their medical team, something that can really affect the outcome of any disease process. With the current insurance environment, even the most skilled physician can't cover all the bases with the time often allotted during a single visit.

And by all means, if you don't have a good relationship or you don't think the physician is listening you need to find care elsewhere. No sense in wasting either of your time.

I know I've fired docs before, simply for not being able to get convenient and reasonable office appointments. If a doc is so busy he can't see you for 6 months and your case requires more frequent visits then what's the use of you being his patient?

I demand time from my medical professionals, but I make sure I know what I am asking and am prepared for every visit I attend. I expect the same from my physician. So far that has worked VERY well for me and I have a wonderful team of skilled practitioners behind me.

Mutual Respect is a wonderful thing and a two way street ! ! !

[Slackwater]

Originally posted by Dave C:
I found this article in the NY Times. Interesting in regards how the drug and Insurance industries are dictating patient care.

Some Doctors concur that insurance companies dictate patient care. I went to the 2008 UCSF Spine Conference, Emerging Technologies in Spinal Treatment (Link) and one prominent surgeon spoke to ADR treatment being "approved" on coverage positions, but only granted if the patient got tremendously involved.

Slackwater

[LBP]

I'm not sure it matters how involved you are as a patient. Ins will do what it wants period. I fought like crazy with PacifiCare and UHC even the CA Dept of Ins. It made no difference. Once I got Aetna, I didn't even have to appeal. It was approved without any battle.

Insurance companies are to blame for everything from lack of coverage to quality of care with your drs.

Lawyers are a check and balance to the medical system. Congress need to let lawyers be a check and balance to the insurance industry! stop blaming lawyers. Without lawsuits, companies/drs would have a hell of lot less incentive to do things in the interest of consumers/patients.

Plus there is a high threshold to sue a dr in a medical malpractice case. Too high in my opinion because I was injured by a dr during surgery that required me to have ADR surgery! But I couldn't prove what went wrong in the first surgery because I was under general anesthia when it happened. Since the medical records fail to admit wrongdoing, I can't prove anything....I wonder why...I'm an attorney, and they are not going to admit in writing what went wrong. In a medical malpractice case you have to have another doctor willing to testify that the alleged wrongdoing dr fell below the relevant standard of care. Plus juries are sympathetic to drs. So gimme a break. Lawyers are not responsible for the lack of care by drs. When things go wrong, you should have a right to seek reddress.

Re Ins companies,there are zero checks and balances with insurance decisions because you can't sue them for their coverage denials even when the procedure is FDA approved. The lack of checks and balances on the insurance indus is why hardly anyone is getting coverage! Ins companies don't want to pay for a bunch more back surgeries. Until gov't changes how health insurance works and makes them more accountable to you as an insured, you are at their mercy.

[Harrison]

Excellent points all around, thx to all to contributing. I think this is an excellent synposis of the problem facing spine patients.

Potentially, there are many ways to "change the system." In actuality, there are few that can be executed that favor both payers and patients. Out of the few solutions, we patients can have a voice in how decisions are made. It's about getting organized and getting our act together to contribute to a patient device registry. What's in the registry? I'll tell you when it is launched -- but most of the work is complete (phew).

I've been talking about this for years. Finally, things are falling into place to make this happen! More in the coming months on another channel.

In the meantime, what prescriptive advice can we offer patients on an individual basis? Sometimes, that may be easier to offer than changing the entrenched, profit-seeking interests.

PS: LBP, hope you are doing better these days. I'll visit your post-op topic.