More Reasons for the Eroding Trust between Patients and Physicians

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 The treatments endorsed by Standard of Care sometimes reflect out-of-date science rather than the latest and best thinking in the field.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.