Economic pressures are destroying the doctor-patient relationship

---and Retired Doc has some compelling anecdotes:

My brother-in-law has coronary angiography following an episode of chest pain and an EKG that "showed some problem." After the cath, he was seen by someone in a white coat that he had not seen before . The white coated,scrub suited man explained the procedure very briefly ( there were " no significant blockages"),gave him several prescriptions and told him to call the office for a followup visit in 6 weeks. My sister said that somehow he didn't seem like a doctor.I told her he wasn't, he was a PA ( I looked him up on the state board's web site).He was later seen by the PA for the office visit.

He relates a few more stories like this, and in no case did the patient get to spend any time with the doctor.

Early in my career I began to notice that in talking with patients about their encounters with other doctors and hospitals they would often relate “they never told us anything.” I knew that wasn’t literally true but was astonished at how often medicalese, lack of time and bad listening could conspire to give patients the perception that they were not told anything. I naively vowed that it would never be said of me. I would make mistakes, my bedside manner was not perfect and not all patients would like me, but to the best of my ability I would give no one cause to say “he never told us anything”.

I developed a particular style of talking with patients. During interviews I would note concerns and questions and at the end would give a “summation.” Then I would ask, repeatedly if necessary, if there were any questions. While most patients left their encounter satisfied they’d had their questions answered sometimes I failed. Occasionally I’d get this call from a hospital nurse: “The family’s upset because Mr. Jones has been in here for a week and no one has told them anything.” Determined to fix the problem then and there I would, unless in the middle of an emergency, drop what I was doing, present to the patient’s room and talk with the patient and family for however long it took to de-fuse the crisis. Too bad if I got home late that night.

Spending this extra time with patients meant I was often behind schedule and could see fewer patients. For the first few years my medical group, appreciative of my unique way of relating to patients, and of my role as consultant-generalist, understood. Over time, though, the economic realities of Stark rules and managed care weighed in and my income tanked. The hospitalist job came to the rescue. As a hospitalist I still try to go the extra mile in answering questions, but time constraints often interfere.

Nowadays after a typical encounter patients are likely to find themselves overwhelmed. Presented with a ream of paper generated by the electronic medical record covering everything from the importance of smoking cessation to the use of seatbelts, patients still often don’t feel they have had their questions answered.