This post was originally published in OJCPCD (On-line Journal of Community and Patient-Centered Dermatology) link: ojcpcd.com
Trust in doctors. It used to be absolute.
If our sick patients improved, we were celebrated. When we failed, families
praised us for trying. This arrangement ws not right, but no doctor went to
any great lengths to change the perception.
About three decades ago, the pendulum
swung. Now doctoring is frequently viewed as market share, self-promotion,
unnecessary procedures and testing. It would seem that professionalism has become
obsolete.
Patients, too, have changed with the
times. Many patients would like to have every test imaginable, expect their health
problems to be cured painlessly, no disruption to social calendars, easy
parking, and why can’t this cancer be cured if man landed on the moon back
in 1969?
Greedy doctors and entitled patients.
Can anything be done to reduce the smoldering hostility? Yes, but not without
considerable effort on both sides.
We doctors don't usually become more
humble during our training. Quite the opposite, we can become more arrogant as we
rise in stature and gain self-confidence. Those without an innate sense of professionalism
and the altruistic dedication that goes with it will have to be taught how to
deal with patients conscientiously, free of arrogance, greed, and conflicts of
interest. More importantly, these skills will need to be evaluated throughout a
doctor’s career. Fortunately, medical schools and credentialing boards have
started to recognize this and are developing methods for teaching and
evaluating such competencies.
In the patient arena, the sad truth
remains that there are no guarantees. Human cell biology is considerably more
complex than rocket science. A single DNA mutation during embryonic development
causes a debilitating, life-long disease. A three-year-old child develops brain
cancer or leukemia. These unfortunate individuals and their doctors have little
control over the causes or outcomes. We should be thankful for what discoveries
have been made over the years, and should expect that our own doctor’s training
and continued medical education reflect that learning.
As for the high expectations of
patients, I suspect they will continue. New drugs and diagnostics get marketed
aggressively. Hopeful patients clamor to get the latest scan or drug they saw
advertised on U.S. television. Most patients don’t understand the risk of harm that
comes from unnecessary testing and treatment.
If patients were to routinely receive
balanced pros and cons of treatments and tests, they might develop more
reasonable expectations. Corporate entities and pharmaceutical companies
certainly will not be providing that balance. We doctors must do it. Some
progress is being made, however: Choosing Wisely®, Choosing Wisely Canada® and
the Conference on Preventing Overdiagnosis are addressing the harm that can
come from too much medicine.
A true patient-doctor partnership?
For doctors, that would mean caring for the whole patient, examining best
evidence before making recommendations for testing and treatment, and placing
patient care above financial gain. For patients, it would mean recognizing that
uncertainty always exists and
that more medicine is not always better medicine. Finally, we all need to
understand that medical decisions must ultimately include not only the wishes
of individual patients and their doctors, but consideration of societal and
public health priorities as well.
