Doctor patient relationship

Why so many patients are unhappy with their doctors, and so many doctors are unhappy with their jobs

A recent study shows that doctors top the list of the most respected professionals in the world. Except of course if you are in Finland, where teachers come ahead, or Japan, where a restaurant chef is also ahead (and why not, if good food is your best doctor?).

People seem to admire physicians’ education and brainpower, and feel that – particularly among some surgical specialties like heart surgery, test-tube babies, eye surgery, cancer surgeons and neurosurgery – some doctors have the ability to save their lives, or at least improve their vision, mobility, memory, energy levels, quality of life, and reduce their anxiety or depression.

But among many other people, there is a growing disillusion and resentment of physicians. Some of this revolves around doctors’ incomes. Other elements seem to be related to the fact that their own physician doesn’t spend as much time with them as they would like, or recommends measures such as laboratory testing, ultrasounds, X-ray and follow-up visits that patients consider driven by money more than care. Some say that their doctor doesn’t appear to be the saint that they believe physicians in general should be.

The truth of the matter is that a large degree of our admiration or disillusionment with doctors is fueled primarily by our idealized concept of what a physician should be.

How did we get to this point?

When asked to describe their vision of their dream doctor, patients often use adjectives like “empathetic,” “careful or safe,” “confident,” “attentive,” “intelligent,” and “passionate.” But they also want a down-to-earth, trustworthy, friendly, respectful, honest, and sincere doctor who is on time and who calls to check on them instead of taking days to return their messages.

That is an unrealistically high pedestal. And these expectations extend to physicians’ lives and behavior outside the office as well. Across the world, if a physician gets a ticket in USA for driving while slightly exceeding the alcohol-blood levels, his medical license is suspended or revoked and the news is splashed in the local newspapers and on Google search engines to follow him or her forever.

How did we get here? Ten years ago (before insurance companies inserted themselves into medicine), we had the physician and the patient. Alone. Fifty years ago, in a bedroom during a house call. The relationship between physician and patient was not poisoned by lawyers or bureaucracy, WhatsApp messages, and telephone gate keepers, and it was unaffected by superbills and insurance documentation or CPT codes.

This dream doctor – our hero in a white coat – who would come to save us any time of day or night still lives in our collective subconsciousness. Doctors dream of being heroes and saving lives, and suffering patients seek a savior. They feed each other’s co-dependency. After all, without patients, doctors would go broke. And many are indeed in this saturated market, where insurance companies have no time to send their expensive and understaffed teams to contract and audit a small medical office.

It used to be a match made in heaven. Right?

Falling From the Pedestal

When doctors fail to meet their patients’ expectations, all hell breaks loose. And fairly quickly. Although most patients are grateful to their physicians, there is a subset who loves them if what they hear from them is consistent with what they need, and hate them if they are told what they don’t want to hear. Patients love their doctors when they make the right medical decisions, but turn on them should there be any complications.

This is another factor behind the unsustainable relationship: Patients do not feel that it is enough for doctors to “do their best.” Rather, patients have an overblown idea of the actual scope of a doctor’s medical knowledge, the availability and sensitivity of all tests, and the capabilities of clinical pathways or evidence-based medicine.

Still, patients tend to love their own doctor and distrust others. When a patient goes to a lawyer to sue his or her doctor for a bad outcome (not negligence), the attorney typically pulls out a list of all the physicians involved in the case for their review before deciding which ones to include in the lawsuit. “Sue them all, except this one – he’s my physician” is frequently the answer.

It is rare for a patient to sue a doctor unless there is a pent-up element of anger and a broken relationship. Without the relationship, patients judge their doctor harshly. Especially when it comes to money.

Judging a Doctor by His Possessions

“If a doctor drives a good car or lives in a nice house especially in smaller cities, they are assumed to have an excessive income. However, if they drive a normal car, they are considered cheap. It’s this “can’t win” feeling that makes it difficult for physicians to discuss certain things they have in common with their patients – be it houses, vacations, schools, or cars.

And it’s not just patients. Even some jealous or idealistic doctors judge their colleagues as rich, greedy, and self-serving.

If that’s how doctors think, imagine what patients are thinking! And yet, are physicians required to be more selfless than other high-earning professionals, such as lawyers and financial planners? Aren’t doctors entitled to be materialistic at times, if they do a good job of caring for people?

Some patients say physicians are indeed very special. Patients frequently say, “I don’t care how much money my doctors make because I know they give up so much of their money and their life to become doctors and help people… But I do care if they spend time to listen to me”.

So, when a patient finds a good doctor who listens to them, they become very attached and very loyal to them.

The truth is that without the personal relationship that takes facetime to cultivate, healthcare becomes a mere financial transaction between a customer and a service-provider. And many burned-out and demotivated physicians these days feel that the doctor/patient relationship is broken forever.

The only respect people have for doctors these days is that they spent a lot of time and money to get their license to practice. They don’t really respect their opinions about their health, because they can find most of the info they need on their WebMD, Wikipedia or on IBM’s Watson computer.

The fundamental problem is that patients don’t think of doctors as humans anymore.
What they love is the ‘doctor aura’. What they hate is the broken system created by the insurance-driven assembly-line system, and the doctors’ new bosses, be it their employers who control their employment and salaries or insurance clerks who authorize their requests for tests or surgery. These new bosses are frequently bean-counters with an accounting background who lack the essential medical education they need to manage physicians and patients. Doctors are perceived to be the face of the system.

Building Trust and Salvaging the Relationship

Restoring the close relationship between doctor and patient is key to mending the broken patient-doctor relationship. To do that, patients need uninterrupted time with doctors, who are not looking at their screens as they talk to their patients and input the data insurance companies and regulators need, but instead are maintaining the crucial eye-to-eye contact.

That is the major problem — time. Yet the doctors’ new employers do not appreciate the time a doctor gives to patients. They view such doctor as slow, lazy or less productive, because he or she cannot handle 30 patients a day. Our current insurance-driven medical system pays so little for the consultation that the employers are driving physicians to deliver bad customer service and bad medicine.

Many doctors are fleeing assembly-line medicine for concierge medicine that emphasizes an integrative or holistic approach where doctors do not practice fragmented care, spend more time looking at the root cause of patients’ problems including their stress levels, food habits, sleep and emotional wellbeing. Ideal doctors are giving up production-driven medicine for relationship-driven models. The challenge is to deliver such care not just for the rich with special insurance plans but for the middle class as well, with assembly-line medicine being offered only to laborers with restrictive policies.

It is one important reason for the high turnover of doctors who keep switching employers or hospitals, yearning for a better employer and a better environment.
I interview several of them every week.

As I have already mentioned, there are a lot of conflicts in medicine – between doctors and patients, between doctors and administrators, and between doctors and other doctors. But ultimately, even though physicians earn a very good living in comparison with the underpaid nurses for example, many doctors put the practice of medicine first, far above prestige and money. They, of course, yearn to belong to practices that offer both.

Patients don’t care about how much doctors know until they know how much they care. And if they care, patients will care less how much money their doctor makes.

Most patients, respect, trust, admire and even love the doctor who gives them time.
After all, when you give someone time, you are giving him or her a piece of your life.

It’s About Time.

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