In striving to be the best doctors, have we lost touch with our patients?

June 1, 2005

The recent cover of a major newsmagazine shows a registered nurse with a stethoscope around her neck and trumpets the following headline: "WHO NEEDS DOCTORS? Your future physician might not be an M.D.-and you may be better off." Since when did those years of medical school become superfluous, those days and nights of internship irrelevant, and board certification and continuing medical education courses meaningless?

The recent cover of a major newsmagazine shows a registered nurse with a stethoscope around her neck and trumpets the following headline: "WHO NEEDS DOCTORS? Your future physician might not be an M.D.-and you may be better off." Since when did those years of medical school become superfluous, those days and nights of internship irrelevant, and board certification and continuing medical education courses meaningless?

The gist of the article (published in U.S. News and World Report, Jan. 31 – Feb. 7, 2005) is that physicians have lost intimate contact with their patients, and that this is a consequence of the changes occurring in our health-care system.

The article describes physicians buried under "reams of paperwork" that "eats away at the time they might spend on other patients." Third-party payers reimburse physicians for less than their costs, so that physicians are forced to see more patients. We have to be sure to document all the systems on our review of systems, lest we be accused of trying to commit fraud. Physicians hit with a frivolous lawsuit often tell me they respond by dramatically increasing the time they spend writing in charts, in an effort to "protect themselves" from the next frivolous suit.

While a medical student and ophthalmologist-in-training, my belief was that patients most valued diagnostic acumen, experience, and technical expertise in their physicians. It was my job to learn all I could about diseases and use that knowledge to help my patients.

After becoming a department chairman, I found that there were many wonderful aspects to leading an academic department. The least wonderful was probably serving as the "complaint department." The most common complaint, accounting for probably 90% of letters, has always been related to time-the physician made me wait too long, then spent very little time with me, and wouldn't spend the time to listen and address my questions. The number of complaints over the years relating to poor diagnostic acumen, lack of experience, or insufficient technical expertise was essentially zero.

Top quality: Listening A Wall Street Journal/Harris Online poll, published in the The Wall Street Journal, Oct. 11, 2004, confirms what the priorities of patients are: 84% of respondents cited listening carefully and being easy to talk to as important qualities in a doctor, and only 58% said having "a lot of experience treating patients with your medical condition" was very important. Fourteen percent changed doctors in the past 5 years because the doctor "didn't listen carefully" and 13% because of being kept waiting too long. At a recent conference, the president of an organization that facilitates medical care for prominent executives was very blunt; his clients value timely, compassionate, and respectful care much more than they value brilliant physicians.

I worry that we are failing to give our patients what they seek. They want empathy, our time, our support, as well as technical expertise. We respond with new requirements for certification to prove our knowledge, new diagnostic and therapeutic technologies, seminars on how to code and document in our medical records, and new ways to "increase throughput," so that we can pay the bills. It may not be our fault that third-party payers and regulatory agencies order us to do some of these things, but that does not change what appears to be a trend for us to become increasingly distant from our patients. We do this at our peril. If we give patients what we decide to instead of what they want, will they answer the question, "Who Needs Doctors?" with "Not Us"?