Thursday, October 30, 2014

Successful Patient: Doctors Writing Books

The November 2014 issue of The Atlantic contains an article by Meghan O'Rourke entitled "Doctors Tell All: And It's Far Worse Than You Think." A little bit of hyperbole that turns out to be justified. It's a fascinating article that I highly recommend everyone read, especially if you're interested in medicine and the future of healthcare in America. And especially if you're a patient or taking care of someone with chronic illness.

O'Rourke discusses the following books by physicians:
  • Being Mortal: Medicine and What Matters in the End by Atul Gawande
  • Internal Medicine: A Doctor's Stories by Terrence Holt
  • Doctored: The Disillusionment of an American Physician by Sandeep Jauhar
  • What Doctors Feel: How Emotions Affect the Practice of Medicine by Danielle Ofri
  • The Good Doctor: A Father, a Son, and the Evolution of Medical Ethics by Barron H. Lerner
  • The Doctor Crisis: How Physicians Can, and Must, Lead the Way to Better Health Care by Jack Cochran and Charles Kenney
  • God's Hotel: A Doctor, a Hospital, and a Pilgrimage to the Heart of Medicine by Victoria Sweet

My first thought after reading this article was that Capitalism has ruined medicine. We need to think about that if we want to rein in healthcare costs and return to a healthcare system that truly cares about and for patients and outcomes and wellness rather than how much to charge for a service and whether or not it's covered by insurance.

As I read, I missed my childhood family doctor, Dr. Sisson. His confidence in his knowledge and skill, and his gentleness with his patients and his words, instilled calm in me and trust. If Dr. Sisson told me to do something, I did it. At the same time, I remember my mother asking him questions, sometimes pointed ones, and he answered every single one, no matter how long it took. Dr. Sisson made house calls. That's rare now. I've heard of physicians in rural areas or much smaller towns who still make house calls, but in a big urban area?  No. Dr. Sisson also wasn't afraid to allow his face to show concern or his relief, or even anger. He possessed bottomless patience with kids. I miss him, which doesn't mean my own medical team doesn't measure up to him.

As I read O'Rourke's article, I couldn't help but wonder what my own primary physician and my four specialists on my medical team thought, how they felt, if they'd agree with the author-doctors, and why they became doctors. My primary physician knows me extremely well after 22 years of being my doctor. I can talk with her about anything. She has found me excellent specialists when I've needed them. I know she cares about my wellness and that I take care of myself. I believe everyone on my medical team thinks and feels about me the way she does, for the most part. But I couldn't help having the urge to send them all copies of O'Rourke's article and asking them what they thought about it.

Illustration: Kevin Van Aelst

As I've written before, communication is the key to a successful patient-doctor relationship. You want a doctor who's a good communicator and a good listener, and you need to be the same. Trust, successful treatments, and good outcomes all hinge on communication. Several of the doctor-authors comment that time restrictions often make good communication nearly impossible for both them and their patients. The time restrictions originate from the need to fit in as many patients as possible in a day in order to be able to make the money the clinic needs to stay afloat.  It was really interesting to read descriptions of the demands on a doctor's time and paperwork wins for eating up the most time when a doctor would rather spend the most time treating patients.

I think insurance companies have played a major role in damaging the practice of medicine. They have influenced more and more what hospitals, doctors, and other healthcare providers charge patients, creating a "need" for insurance for patients who cannot afford the costs on their own. It's a sinister loop that we're all stuck in. Which makes a single-payer system that much more appealing (and needed).  Break the loop. For those in America who oppose the single-payer system, let me just say that we already have a single-payer system in place for all people aged 65+.  How much would it take to extend this system to everyone?

Another way to break the loop is to eliminate the need for insurance coverage except for hospitalizations and chronic illnesses.  Force the providers to lower their fees so that patients can pay out of pocket. Eliminate one layer of paperwork (to insurance companies) and open up medical care to the doctors' control again.

Once again The Atlantic has covered an important issue in a thought-provoking and intelligent way.  Please take a few minutes to read this article and open up a discussion with your family, friends, and your medical team.....

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