Distrust of the Medical System (well-earned, I say!)

http://www.nytimes.com/2008/07/29/health/29well.html?th&emc=th  

July 29, 2008

Well

Doctor and Patient, Now at Odds

By TARA PARKER-POPE

A growing chorus of discontent suggests that the once-revered doctor-patient relationship is on the rocks.

The relationship is the cornerstone of the medical system —nobody can be helped if doctors and patients aren’t getting along. But increasingly, research and anecdotal reports suggest that many patients don’t trust doctors.

About one in four patients feel that their physicians sometimes expose them to unnecessary risk, according to data from a Johns Hopkins study published this year in the journal Medicine. And two recent studies show that whether patients trust a doctor strongly influences whether they take their medication.

The distrust and animosity between doctors and patients has shown up in a variety of places. In bookstores, there is now a genre of "what your doctor won’t tell you" books promising previously withheld information on everything from weight loss to heart disease.

The Internet is bristling with frustrated comments from patients. On The New York Times’s Well blog recently, a reader named Tom echoed the concerns of many about doctors. "I, as patient, say stop acting like you know everything," he wrote. "Admit it, and we patients may stop distrusting your quick off-the-line, glib diagnosis."

Doctors say they are not surprised. "It’s been striking to me since I went into practice how unhappy patients are and, frankly, how mistreated patients are," said Dr. Sandeep Jauhar, director of the heart failure program at Long Island Jewish Medical Center and an occasional contributor to Science Times.

He recounted a conversation he had last week with a patient who had been transferred to his hospital. "I said, ‘So why are you here?’ He said: ‘I have no idea. They just transferred me.’

"Nobody is talking to the patients," Dr. Jauhar went on. "Everyone is so rushed. I don’t think the doctors are bad people – they are just working in a broken system."

The reasons for all this frustration are complex. Doctors, facing declining reimbursements and higher costs, have only minutes to spend with each patient. News reports about medicalerrors and drug industry influence have increased patients’ distrust. And the rise of direct-to-consumer drug advertising and medical Web sites have taught patients to research their own medical issues and made them more skeptical and inquisitive.

"Doctors used to be the only source for information on medical problems and what to do, but now our knowledge is demystified," said Dr. Robert Lamberts, an internal medicine physician and medical blogger in Augusta, Ga. "When patients come in with preconceived ideas about what we should do, they do get perturbed at us for not listening. I do my best to explain why I do what I do, but some people are not satisfied until we do what they want."

Others say the problem also stems from a grueling training system that removes doctors from the world patients live in.

"By the time you’re done with your training, you feel, in many ways, that you are as far as you could possibly be from the very people you’ve set out to help," said Dr. Pauline Chen, most recently a liver transplant surgeon at the University of California, Los Angeles, and the author of "Final Exam: A Surgeon’s Reflections on Mortality" (Knopf, 2007). "We don’t even talk the same language anymore."

Dr. David H. Newman, an emergency room physician at St. Luke’s-Roosevelt Hospital Center in Manhattan, says there is a disconnect between the way doctors and patients view medicine. Doctors are trained to diagnose disease and treat it, he said, while "patients are interested in being tended to and being listened to and being well."

Dr. Newman, author of the new book "Hippocrates’ Shadow: Secrets from the House of Medicine" (Scribner), says studies of the placebo effect suggest that Hippocrates was right when he claimed that faith in physicians can help healing. "It adds misery and suffering to any condition to not have a source of care that you trust," Dr. Newman said.

But these doctors say the situation is not hopeless. Patients who don’t trust their doctor should look for a new one, but they may be able to improve existing relationships by being more open and communicative.

Go to a doctor’s visit with written questions so you don’t forget to ask what’s important to you. If a doctor starts to rush out of the room, stop him or her by saying, "Doctor, I still have some questions." Patients who are open with their doctors about their feelings and fears will often get the same level of openness in return.

"All of us, the patients and the doctors, ultimately want the same thing," Dr. Chen said. "But we see ourselves on opposite sides of a divide. There is this sense that we’re facing off with each other and we’re not working together. It’s a tragedy."

well@nytimes.com

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Too many doctors have only themselves to blame.

As Dr. Jerome Groopman wrote in "How Doctors Think", they often leap to conclusions after hearing just a few symptoms, and then ignore any evidence that they are wrong.

In 1988, I received a diagnosis from a virologist. That diagnosis was later confirmed by another specialist. Yet, in 2000, a PCP who was bound and determined to see a depressed divorcee convinced himself that both experts were wrong and he was right.

Had this doctor been honest with me upfront, that he does not know the first thing about the condition I was previously diagnosed with, I would have gone to someone else, no harm, no foul. Instead, he strung me along for months with empty promises that I'd get the tests I wanted and the referral to the specialist "next time" -- his ego was more important to him than my health. Now, because of him, I cannot work full-time, but I am also precluded from getting Disability benefits.

His best defense was "nothing you said made sense" ... which is true: nothing that I said made sense in the context of post-divorce depression because I was not describing depression. I was describing a post-viral neurological condition. But he'd already made up his mind what he was supposed to hear, and discarded all the puzzle pieces he was given that would have produced the correct diagnosis.