Who Will Take Care of You?
A growing gap separates doctors and patients. The new healers are now stepping in to fill the void
It is no longer a happy marriage, this relationship between doctors and patients. A bond once tight with intimacy is under incredible strain. Doctors have changed. Patients have changed. The caring is gone. Well, not gone but buried under the crush of everyday life. Buried under insurance headaches as patients now come burdened with reams of paperwork for doctors to fill out for reimbursement, paperwork that eats away at the time they might spend on other patients. So do fees, doctors say, because what insurance pays them is well below their costs. So in a vicious circle that steals more time, they have to see--and bill--a lot of patients each day and shuffle them out of the office no matter how much attention they might really need. "Family physicians are getting stressed to the max," says Mary Frank, who is president of the American Academy of Family Physicians and has a private practice in Rohnert Park, Calif., north of San Francisco.
Patients, for their part, frequently switch insurance plans to save money, but changing plans means changing care, because the new plan may not cover the old doctor. Nobody gets to know anybody anymore. "Look, docs are nice people, but they're really time pressed," says Todd Ringler, 37, a public relations executive who lives in Swampscott, Mass., outside of Boston. "I found I wasn't able to have conversations that went beyond 'Tell me where it hurts. What's the level of your pain, from 1 to 10?' If you can't go further than that, you can't develop honest communication about your health or health problems."
And going further turns out to be much more than a touchy-feely relationship issue. It is, in fact, vitally important to the patient. Research has shown that a good conversation that thoroughly explores problems and possible treatments means better health. Physician Sheldon Greenfield and social scientist Sherrie Kaplan of the University of California-Irvine and their colleagues, in an oft-cited series of studies, audiotaped doctors' discussions with a variety of patients, including people with ulcers, diabetes, high blood pressure, and HIV. Some of these patients asked more questions about their illnesses and how to manage them and participated more in developing a program of care. These patients and their physicians said they had the best communication. And after they completed these visits, these patients also had the best control over their blood sugar and blood pressure levels, reported fewer limitations on their lives, and took their HIV medications on schedule. It's not really surprising that they did better with their treatments. After all, they had an active role in devising them, a role allowed by these detailed conversations with their physicians. The doctor-patient relationship, the researchers concluded, "must be taken into account."
"This relationship has clearly been shown to affect diagnostic accuracy, adherence to treatment plans, and patient satisfaction," says internist Wendy Levinson, chair of medicine at the University of Toronto. "And the most important part of patient satisfaction is communication with the doctor. Repeatedly, we've found that people will put up with hassles like longer waiting times if they have this good relationship."
advertisement
