I have been fortunate to practice medicine during an era of great scientific progress. The pace of this transformation remains exponentially greater than at any other time in human history. Just a few decades ago, there was only a comparatively limited pharmaceutical repertoire. Imaging was distinctly primitive compared to current computer enhanced techniques. The sciences of genetics and immunology were just emerging in modern form.
Yet, as is true with all aspects of human experience, progress of one sort can have its shadow side. In an attempt to match our worthy instincts to expand access to care and still cope with increasing costs, we have been simultaneously propelled towards an inadvertent yet consequential social experiment. As we go forward, if the system that is being erected distributes care episodically and through many fragmented providers, in whom we will place our trust in matters of health?
This was never a pervasive issue in another age. Despite significant limits in effective patient treatment up until the recent past, many people had a personal and valued relationship with their own physician. Paradoxically, when little could actually be done, the stature of the medical profession was at its zenith. Trust in one’s own personal physician used to be extremely high and was an unheralded and essential linchpin in our medical experience. Throughout history, that specific bond between treating physician and sufferer was considered a crucial element in patient care and this has been the case since the shaman’s chant.
However, our rapidly changing system has made no overt attempt to recognize this relationship. Yet, it surely matters and likely accounts for the unprecedented recent growth of boutique medical practices. The well-to-do want to assert their right to access medical practitioners in whom they place deep trust.
In an earlier era, the burden of decision-making was typically placed on the physician. Any trusting patient had the comfort of being able to accept a course of medical therapy without deep inner conflict. How quaint and ill informed that would seem to many sophisticates today. But in truth, who is better equipped to undertake the decision? The willing transfer of decision making from patient or family to physician can only be based on a trusting bond between physician and patient. Up until the recent past, those relationships were often present and expected. Such bonds permitted a degree of latitude in the practice of medicine that young practitioners cannot even imagine in our current regulatory environment. In many respects, it served both patients and families very well.
It is different now. Patients are expected to fully participate in complex decisions about their care. Frequently then, choices are made after a cursory examination of incomplete sources based on an urgent Internet search. The results can be confusing, jargon filled, and statistically dense. Although important information can be gleaned, that same process may yield incompletely understood perceptions of risk, unrealistic expectations, or the inadvertent undermining of realistic hope. What is gained in one sense can be lost in another.
What might we make of this dilemma? For our policy makers, there should be an overt appreciation that such a sense of trust can only be preserved through the traditional link between personal and familiar physician and patient. That trust, and the faith in healing that under girds it, has worth. And that faith, once lost, is not easily regained.
Importantly, trust is never a unilateral phenomenon. Any patient must feel assured that their physicians are not scrambling to enhance their incomes by becoming improperly inured by pharmaceutical manufacturers, medical device makers or from competing health systems. Trust is always fragile and must be earned and maintained. Perhaps this is nowhere more true than was demonstrated with our recent experience with Ebola. Our leaders and our medical bureaucracy inaccurately asserted that our health system was fully prepared to monitor and very efficiently deal with Ebola. In real time, at least with the first few cases, our system was shown to be under prepared. Episodes such as this undermine that imperative of trust.
Any breakdown of the system of the healing arts which has existed throughout human history will have significant unpremeditated consequences. It will be costly in terms of insecurity, doubt and worry, futile or fringe treatments or effective therapies unsought. As a nation, we have embarked without adequate reflection on a vast new societal experiment lead by policy makers whose primary concern is process and political popularity. It is highly likely that for their own medical care, these same individuals will insist on the prerogative of medical circumstances and personal medical relationships in which they feel a sense of trust. They will demand that their care be delivered by those in whom they have faith. Should we not all be allowed the same? Let us insist then that our policy makers remember the place that trust, faith, and the healer’s heart have on our own lives. I offer this admonition to our policy makers, “Wherever the art of medicine is loved, there is also the love of humanity.” – Hippocrates
Dr. Bill Miller has been a physician in academic and private practice for over 30 years. He is the author of The Microcosm Within: Evolution and Extinction in the Hologenome. (Photo by CBS Television via Wikimedia Commons)