For physicians, regaining society's trust is only a matter of "time"

In her April 16, 2009 health blog (www.nytimes.com) Dr. Pauline Chen mentions that one of her medical heroes, Dr. Thomas E. Strarzl believes that one of the most important things that needs to be done in medicine is to regain the trust of the public, although he didn’t say exactly how to get that trust back.

Clearly, society’s loss of trust in medicine is one of the reasons that the cost of health care rises relentlessly. For it is the lack of trust that compels doctors to order as many tests as necessary to rule out almost every imaginable reason for a patient’s symptoms. For unless this over-vigilant (and wasteful) approach is taken, many patients will question their doctor’s thoroughness and competence and if in the future what the doctor considered to be a simple cold or headache turns out to be a lung cancer or a brain tumor they are likely to sue the doctor. Both of these examples are not as exaggerated as they sound. Many physicians have had situations where a simple symptom later on turned out to be a serious problem and many of them have been sued.

The decline of the doctor-patient relationship is, if not at the center of the decline, very close to it. Ironically, over-reliance on imaging and laboratory testing, instead of making health care better has diluted the connection and trust that many regarded as the hallmark of our profession. Of course, insurers’ control of the way doctors practice and consequently their integrity and professionalism has added to the problem.

The best way to regain that trust is for doctors to spend more time with their patients. That means that physicians will have to see fewer patients per day. There is no substitute. Using nurses and physician assistants as surrogates is not the answer. Although they are well-trained and very good at what they do, until they become fully licensed to practice independently, these professionals should not be burdened with what are ultimately physicians’ responsibilities.

Obviously, there is a financial downside here because until insurers’ greed is controlled and doctors are paid fairly for their labors, doctors who do voluntarily see fewer patients will see their incomes drop. Every doctor will have to find his or her own comfort level of financial downsizing. Not all will be able to do it but those who do will be doing a great service and perhaps if their medical societies acknowledged their sacrifices, more would follow.

Ed Volpintesta MD