LAUSR

The physician–patient relationship is no less important than the treatment of the patient’s disease itself. Sadly, both this relationship and the treatment aspect of practicing medicine have undergone undesirable changes in the recent past – and the future is hardly promising. What follows below is two doctors’ view on this crucial topic, based on a combined experience, from numerous countries, of over 50 years. In the not-so distant ‘good old days,’ if a patient felt the need to see a doctor, he called for an appointment, and the doctor would see him on a very short notice. Once entering the office and seeing the clerk, he was ushered in to see the doctor without too much wait. The doctor took the history himself, ordered the appropriate tests, based on which the patient received reassuring words (‘it is a benign condition, there is no need for any treatment’), a prescription, or was referred to a facility with specialists. Sadly, we live in a new reality. Today, the patient calls the doctor’s office, and the appointment is weeks or months into the future. (If the condition is urgent, the ER offers an impersonal, expensive alternative.) The actual doctor’s visit begins with the patient registering with a clerk who first asks for the insurance card – with luck that particular doctor accepts that particular insurance. The clerk then asks for signatures on multiple incomprehensible consent documents. Next, the patient receives another form to fill out, which largely replaces the taking of the history. Afterward, the patient waits: doctors are always running behind. Finally the nurse/technician calls. She repeats the questions already asked on the form, performs numerous tests based on certain protocols, and instructs the patient to wait again until at last the doctor arrives. During the encounter, the doctor barely looks at the patient: he must review the paperwork so far gathered, transfer the information into the computer, and tick off a checklist of tasks. The patient–doctor dialog is substituted by a computer–doctor dialog; in fact, much of the nurse–doctor dialog is also done on the computer so that a written record is preserved for the audit. With minimal time for eye contact and examination, the doctor makes the diagnosis – and now the therapy must be chosen. The selection used to be based on his personal experience, supported by what he ‘objectively’ knew about the disease in question (literature data, various forms of interaction with peers, etc.). But what are the major factors today that determine the choice of a particular therapy? The input comes from numerous sources; below is an incomplete list.