Diagnosis for Democracy
Insights into the State of Our Union
A Blog by Rob Tenery, MD


The Changing Role of the Health Care Professional

By Rob Tenery, MD on December 19, 2016

Illness is mankind’s common denominator. The delivery of health care is the practice of the science of medicine with compassion thrown in. Medicine is a relatively young and imperfect science that is controlled by the laws of nature. As the knowledge base grows, so does the ability to predict and control outcomes. The practitioners of the medical profession are not selling a product, but are sharing their knowledge and expertise.

The term “calling” is usually reserved for those fields of endeavor where the ultimate goal is to accomplish good for others. There is even the inference of influence by a higher power. To many who deliver health care services, medicine is still their calling. To them, there is an implied dedication of purpose and personal reward that comes through self-fulfillment.

In the past, most doctors held a shared vision of what it meant to be a physician. It was the foundation on which the medical profession was established and evolved, not from one generation, but many. That goal also served as the pillar on which patients built their trust.

As physicians grapple with their increasingly complex roles as scientists, business persons, and ministers to their patients, there is a growing fragmentation in the physician community.

This realignment is diverting physicians away from addressing the core problems that are eroding this profession’s autonomy. The beneficence and compassion of their forefathers is being strangled out by liability concerns and compounding regulations that are being heaped on them—the very qualities they had hoped to emulate when first choosing medicine as their life’s calling.

This is not to imply any less dedication by physicians today. It is a resetting of priorities. Although health care with respect to the science and the outcomes is vastly better, there is a proportionate increase in the depersonalization of the doctor/patient relationship. Often, the examination and history are secondary to the diagnostic studies. Doctors spend more time reviewing the charts, test results, and X-rays than being with their patients. They tend to talk more to consulting doctors, dictating machines, and nurses than to their patients. As the science expands, the personal side of health care delivery diminishes.

There are a growing number in the profession of medicine who equate their patients to customers—those who purchase a product or service to fulfill a given need or desire. That line of thinking makes the relationship transactional. Patients are paying for services rendered and not guaranteed results, somewhat akin to firemen and policemen. Rather than a contract, the relationship should continue to be personal and based on commitment with the intent of benefit as opposed to financial reward.

Until recently doctors and their patients have had long-standing relationships. With dictates by managed care coverage, increasing specialization, and expanding technology, no one physician can keep abreast of all medicine’s advances. Especially with complex problems, there is a “team” approach: multiple physicians, multiple disciplines. All too often, the members of the team don’t communicate—leaving the patient with the often-quoted response, “You’ll have to talk to your doctor about that problem.” What doesn’t change is the need for continuity of care. This means that the continuity of caring must remain constant throughout the illness. And “being there,” not always in body but spirit to help the patient face any unknowns that lie ahead; not always the same doctor, but a doctor that they can communicate with about their illness. Someone who doesn’t think of them as a number or a diagnosis to take it all in, shows a little compassion, and lets them know that they are not in their struggle alone. The names and the faces change but the relationship cannot. Every patient still needs his or her own doctor.

While advancing the technical aspects of the medical profession, the physician community has failed to preserve many of the privileges and freedoms that were enjoyed by past generations of doctors and their patients. Some would consider this loss a failure by our current generation. A far greater failure would be if they did not instill in those that follow the desire to continue to work for and restore those losses. Too often today, society has turned inward to individual need, ignoring one’s commitment to the larger picture.

A particular physician’s role will be judged not by how much money he or she earned or the number of procedures performed. Physicians will be judged by the patients under their care and the physicians who take over after they are gone. If medicine is better for what the physicians have done, then the profession is well served.*

* Article excerpted from In Search of Medicine’s Moral Compass, Tenery, R., Goodman, L., The Small Press at Brown Books Publishing, 2011. 





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