I’ve just been reading an article by James F. Sweeney, “The
Eroding Trust Between Patients and Physicians”, that appeared in the 4/10/2018
issue of Medical Economics. First, I appreciate the fact that Mr. (Dr.?)
Sweeney is addressing this issue, which is a serious detriment to effective
medical care. Lack of time and of any substantial relationship with the patient
are the causes emphasized by Sweeney, but there are a number of others that
deserve attention.
Standard of Care
imposes constraints that encourage doctors to play it safe and avoid
creative thinking. Especially in the field of oncology, the threat of liability
intimidates many doctors and may cause them to see each new patient as a
potential lawsuit. The treatments endorsed by Standard of Care sometimes
reflect out-of-date science rather than the latest and best thinking in the
field.
Reliance on randomized
controlled trials (in addition to lack of time) means that patients tend to
be treated by category. RCTs are useful as an overall indicator, but they don’t
tell the physician anything at all about a particular patient.
Medical offices
frequently don’t have accurate, long-term medical records for patients.
With the advent of electronic records, decades of precious data on individual
patients were discarded and lost. Unless the patient herself has kept hard
copies, the doctor must make recommendations based on a couple of years of test
results. Adding to this problem is the lack of compatibility among EMR systems.
The connection between
medical practice and science is becoming more tenuous. Protocols for some
tests are not followed correctly. (My favorite example is the taking of blood
pressure, when medical offices don’t have you sit quietly for a few minutes
beforehand, the correct protocol. Then they tell you that you have high blood
pressure.) We hear confident statements that calcium supplements promote heart
disease, when the evidence for this is shaky at best. Medical practice tends
to cherry pick scientific studies and highlight those that support what it is
already doing.
In spite of substantial
scientific evidence supporting the role of diet and exercise to good health,
many medical practitioners discount their importance. Ads for medical
practices and hospitals featuring photos of overweight doctors and nurses are
clear evidence of this attitude.
Current medical
practice tends to reject, even scorn, any therapy that isn’t part of the
conventional canon. After developing painful scar tissue in my shoulder and
arms, I was successfully treated by a chiropractor with myofascial therapy
(MRT) and active release technique (ART). Conventional medicine’s
recommendation? Pain meds or surgery.
These are all features of medical practice today that are
causing physicians to lose credibility in the eyes of their patients.
