Medicine at a Crossroads

The dying art of patient care

When you last went to the doctor, did you feel they tried to listen and explain...or did it feel like he took a guess at which medicine was going to make you better?  Did you feel more like a patient or a customer at a diner?

Our nation is engaged in a potent discussion over medicine, mostly over who is going to pay the bill.  Who gets coverage?  What coverage do we get?  Important questions.  More importantly, who's making these tough decisions?  I believe we're missing a huge issue about what role a doctor plays in our care.  It's like we're at the dealership haggling over price and financing without asking what car we get.  If we end up without a listening expert who will help us make good health choices, what car are we driving?  I believe now more than ever, we need an expert adviser who will help us negotiate questions of surgery, medications, and therapy options.

Psychiatrist Dr. Donald Levin offers an example of the compromises currently demanded by our health care decline.  In a recent interview (http://nyti.ms/fWL7tS), he described how as a result of managed care pressure, he was no longer seeing patients 45 min, with time to listen and solve, but rather 15 min visits to adjust medications.  Dr. Levin reveals, "I had to train myself no to get too interested in their problems."  This change in psychiatry is one of many areas of medicine that have shifted dramatically away from a model of 'listen, diagnose, & teach' to one of 'interject, order tests, & prescribe'.  Most upsetting, this shift is happening despite evidence that quality of care is greatly suffering. 

Dr. Levin's son is pursuing his own career in psychiatry.  Dr. Matthew Levin stated, "I’m concerned that I may be put in a position where I’d be forced to sacrifice patient care to make a living, and I’m hoping to avoid that."  Hoping?!  Well, I'm hoping our nation demands that quality patient care continue to be a ethical mandate for all physicians, not a secondary question to who else in lining their pockets.

The current drive of medicine to produce assembly line results offering an algorithmic response to human health denies value in our uniqueness as individual patients and the dynamic ways in which we respond to care.  We would do well to demand health care that puts the patient first--instead of the insurance companies reimbursement rates or a physician's changing salary.  We're trading a sit down family meal for a drive through hamburger...and paying more for it!  The cost is the declining quality of patient care and higher costs for all.