Tuesday, June 18, 2013

Demand Apathy

Monday afternoons are always the same.  I pick up the kids from their grandparents.  We drive home with their backpacks and a carton of home made food.  We park in the garage, and carry all the contents of the car into the house.  As the kids unload, I push the recycle container to the front for street pickup the next day. 

Occasionally, I stop and socialize.  Yesterday, I waited at the edge of the sidewalk as a neighbor approached.  A young healthy fellow, I was surprised to see his posture stooped and his head bent forward.  Apparently he was under the weather.  He had a slew of symptoms: fevers, chills, and a sore back. 

I enquired about his recent doctors visit.  His physician was top rate, I had suggested him myself.  But that's when my neighbor's face became particularly animated.  His visit  the week before had ended in blood tests and an Xray.  But seven days later, no results.  In fact, several calls over the last forty eight hours had been left unanswered. 

I shook my head, and watched him stumble into his house.  I knew his doctor to be of high quality, but ever since he had been bought by the local hospital, the number of complaints had risen.  It was a common issue.  A few patients each week were showing up at my doorstep because they felt like the practice they had been going to for years no longer cared for them. 

I would like to believe that this was only happening in the big medical groups, but I have heard the same among private practices also.  And sadly, I feel fairly certain that I know why.

In the old world, physicians answered only to one master: the patient.  In the new world order, patients are becoming a lowly voice in the crowd of entities shouting at physicians.  There is a kind of demand apathy.  After tending to the insurance companies, the government, the hospital, the medical group administrators, and the electronic medical record, your physician may or may not have time to address your needs.

We talk of the devastation of physician suicide.  We lament as more and more doctors bow out of clinical practice.  But on a larger scale, what may be most harmful to the American populace is the great apathy that is sprouting in this once proud profession.

My neighbor will eventually get better.  The virus attacking his system will abate.  The inflammation will resolve.

His trust in the system, however, has suffered a mortal blow.


william Peace said...

I am new to your blog. I am deeply distressed about the current state of medical care. grew up and went through the medical mill with profound neurological deficits from 1969 to 1978 and truly suffered. I was healthy the next 32 years and was stunned when I became seriously ill in 2010. The compartmentalization of health care has had a terrible influence on compassionate medical care. It does not exist in fact. In the absence of medical technology 30 years ago little could be done to help me. Today we have what Dan Callahan has called the beast, high tech medical care, and no compassion. At issue is why[. You suggest a few things here but to me the hospitalist concept is a scourge. Doctor patient relationships are now poisonous and ethically flawed. What do you suggest can be done? Is the situation hopeless?

Anonymous said...

Hi Jordan,

You write that, of the entities vying for the doctor's attention, the insurance companies, the government, the hospital, the medical group administrators, the electronic medical record, and the patient, it is the patient for whom the doctor may or may not have time.

That makes perfect sense to me, since those other entities are permanent; they are here to stay, forever.

The patient's presence alone is temporary,... when he dies.


Anonymous said...

The thoughts are dead on the money. This is exactly what I'm seeing. Thanks for the eloquent way of voicing it.

sjdmd said...

Sobering and all too true, I fear. As a physician who has worked as a leader building systems for care delivery and improving how we deliver care I'm increasingly chagrined by how measurement of whatever metric has trumped patient benefit. I'm increasingly looking at Society for Participatory Medicine as a potential leader in reactivating the patient-physician bond for this new era. http://participatorymedicine.org/