Friday, May 25, 2012

The Opacification Of Intent

There was a time when the humble physician traveled to each patients home.  Care was rendered at poorly lit bedsides with a stethoscope, a pat on the back, and whatever medications could be fit into a small black bag.  Payment was cash, or barter, or services were provided for free.  As the doctor packed his tools and left the house a few ticks past midnight, there was no questioning the nature of the man who walked through the door.  The intentions of the profession were abundantly clear.

Years later, medical science has advanced far past the boundaries of these so called dark ages.  People are living longer, healthier lives.  Although the scourge of disease is being successfully battled on every front, the doctor-patient relationship is more fractured than ever.  We have lost the position of our brother's keeper.  Suspicion and anger have become empathy's uncomfortable bedfellow.

So what has changed?  The doe eyed medical student who cautiously peers into the room of her first hospital patient is lauded.  This poor soul has emptied her bank account and devoted countless hours to master the self serving mistress of knowledge.  The frail, emaciated, cancer riddled patient reaches his hand out to her, even as his body is failing.  For they are comrades who struggle and suffer together.  No one doubts what drives the student's heart.

As one advances into practice, a metamorphosis occurs, and thus begins the opacification of intent.  A geographic barrier is formed when a patient has to travel to the physician's office.  Medicare and the modern insurance complex cause an economic barrier as the patient is required to disclose payment information even before an appointment is made.  A physical barrier is placed between doctor and patient as we hide behind our electronic medical record and use technology in place of touch.

We have allowed for the institutionalization of empathy and we suffer the consequences.

Yet I still believe our intentions are pure.

1 comment:

Anonymous said...

It is not this way everywhere. My PCP may have to check my chart to remember the details of our relationship, but he's taken sufficient reminders to recall a few personal items, and everything I've thought might relate to my medical well-being. I know that, ten minutes later, he's doing the same with the next patient, but I know that's how things need to be. This is merely a faster version (needed for the doctor/patient ratio here) of my childhood doctor.

It's still out there. The big, brown eyes may be sanded down, but the good heart is still in the middle. You don't have to dig far to find it -- or maybe I caught a bit of luck.

But take heart -- it's not gone from the face of Western Civilization.