Health Watchers' News and Views

Prevention is All about the Doctor-Patient Relationship!

by Erika T Schwartz MD on 24/08/09 at 4:24 pm

After more than thirty years of practicing medicine, significant personal media exposure and being an avid listener of those who deliver the care and those who debate it, I wonder what exactly is wrong with our country. We are the leading industrialized nation in the world. Or are we? We boast the best standard of living, yet we have fallen behind in all health care parameters except spending.

A few nights ago I watched the CNBC program Round Table on Health Care and it was mostly more rhetoric and pundits listening to themselves talk. Unfortunately that is about all you get these days in the media when speaking of health care reform. One exception at this round table was Michael Milken. Among doctors and politicians he told the truth: It’s All About Prevention.

Health care as we now practice it is never going to really help the millions of Americans who are obese, who smoke, who drink and don’t take care of themselves. Lack of Prevention will only help the drug companies, insurance company trusts, surgical suppliers and technological testing companies make more money at the public’s expense.

It’s all about prevention, but how can you even begin to address prevention when the real implementers of prevention aren’t even part of the discussion? I’m referring to the doctor-patient relationship which ultimately makes or breaks the entire system. Remember Dr. Welby? Remember when doctors were beloved and patients were respected and cared for? Those were the days when the cost of healthcare was not prohibitive. In those days genomics and MRIs were scarce but good will and health were abundant. What changed?

Medical training in the US is funded by a combination of federal, state, endowments and special interest (primarily drug company) monies.

The Indoctrination of Doctors Causes Alienation from Patients

To become a doctor you have to work extremely hard for four years, then a few more years to train to be a clinician and specialist. You work non-stop, rarely sleep, eat junk foods and just try to survive. When you have completed this insane amount of training you are faced with a sad state of affairs. You have a pile of debt and work options are often decided on how much money you can make to catch up. Remember that at this point you are at least 30 years old.

While you were training to be a doctor something very important happened. A paradigm shift took place in your brain. By the time you finish your training you no longer see the world from your original perspective of saving the world. While you weren’t sleeping and diligently trying to be the best student and resident in your program, the indoctrination from the special interest groups who were paying for your education was going on full force.

The result: gradually you became a prescription drug pusher, a product utilizer, a physician who will send every patient for a myriad of senseless and intimidating tests, surgical procedures and the ubiquitous hospital stay. Within 10 years from starting medical school you become a robot in the service of special interests. I know it, I lived it and I watched all my friends live it also. I speak from a position of deep understanding, knowledge and experience. The outcome is often devastating. While many physicians do not fall prey to this exact sequence of events, there are far too many who do. Fully trained doctors no longer see patients as human beings.

Malpractice threats, the business and politics of medicine have only served to rob too many a doctor of his/her most powerful healing tool, their humanity and have permanently changed the interaction with the patient. The patient is another symptom or disease, a nuisance, someone to protect yourself from, to get rid of as fast as possible until the entire profession becomes a mere conveyor belt of human parts. Bedside manner, listening to the patient and caring are not on the medical school curricula. Medical training isn’t focused on encouraging physicians to become primary care practitioners, internists focused on preventing disease and maximizing health. There is no course in medical school on doctor-patient relationships, patient advocacy, compassion or learning how to listen to your patients.

I wonder why? Certainly the outcome is scientifically and common sense proven to be better when the doctor and patient work together and trust each other. It certainly is a lot less expensive to listen than to do lots of testing and write prescriptions for every patient we see…

Didn’t We Become Physicians to Save?

Physicians have a one master; the patient. To serve the patients and no one else, to refuse to be brainwashed and to open our minds and hearts to providing the best care in kindness will save the healthcare system. Didn’t we become physicians to save, after all?

To change the present predicament physicians must focus on keeping the patients healthy, on prevention. This involves learning nutrition to provide nutritional advice, lifestyle and exercise advice as well. And one more thing: physicians must learn to take care of themselves. They must start to address their own diet, exercise, sleep, stress and lifestyle issues to become examples of healthy living and prevention. I bet that approach will help improve the health care system in a heartbeat.

The Patient Must Find the Right Doctor

Now let’s look at the patient for a moment.

When I went into private practice more than 20 years ago, a man came to see me. When I asked him what I could do for him, he said, “How should I know? You are the doctor.” Herein lies the biggest problem the present healthcare system capitalizes on. No one knows how you feel and what goes on inside your body better than you do. No doctor will ever know you better than you know yourself. Until we know that fact, we will not be able to command better health for ourselves, and will run the risk of becoming victims.

If you want to learn please hear me! The doctor has no idea how you feel. The doctor has a lot of information that he/she learned in medical school, training and practice but all that information does not necessarily apply to you. If you don’t explain how you feel and your doctor doesn’t hear you, you will never get the right care. That is an absolute fact. No matter how great the doctor is, if you don’t take responsibility for creating a positive outcome you are at risk. If the doctor doesn’t listen to you and doesn’t pay attention to your complaints, leave. You are better off with no care than with bad, sloppy or uncaring care.

It all goes back to the doctor-patient relationship. Like every other relationship in your life, you must work at it and you cannot ignore it. Your doctor must be your advocate, you two must be philosophically aligned. If you believe in alternative medicine and your doctor doesn’t you are with the wrong doctor. If you want to take bioidentical hormones and your doctor tells you they are a marketing term, don’t argue, change doctors. If you trust conventional medical treatments and your doctor wants to give you supplements and herbal remedies leave. If you are on the same page with your doctor you’re heading in the right direction.

Life is to be lived outside the confines of the health care system. The right doctor will understand that, help you stay healthy and live your life without fear or doubt. If most of us doctors and patients heed this advice we will implement the health care reform we need in this country and set an example for the world to follow.

That is when we can say the US is the leading industrialized country in the world.