Health care should be a human interaction, not a business transaction

Growing up, I never really thought about what it meant to be a doctor, even though it was a path I was destined to travel from a young age. I went to medical school, did a residency in internal medicine and a fellowship in rheumatology. Ultimately, I joined a private […]

Growing up, I never really thought about what it meant to be a doctor, even though it was a path I was destined to travel from a young age. I went to medical school, did a residency in internal medicine and a fellowship in rheumatology. Ultimately, I joined a private practice in 1992.

All was well until 1999 when a frivolous lawsuit shattered my world. As a physician, getting sued for malpractice is a lot different from, say, a driver getting sued over a car accident. It attacks your core identity. I was devastated. For a variety of reasons, mostly fear, I settled the lawsuit, even though I knew I had done nothing wrong. I was filled with rage and I became politically active for the first time in my life.

The initial issue was tort reform, but over time, I became very aware of the many other issues in health care that compromise a physician’s ability to provide proper care.

There are numerous examples. Prior authorization requirements from insurance companies, which have never seen the patient, result in delays or denial of care. Demands for excessive documentation result in physicians having less time to actually care for patients. Corporate entities promote policies that would allow those without a medical license, medical degree or adequate medical training to practice medicine.

Those who seek to control the health-care dollar have systematically devalued physicians and diminished the patient–physician relationship that is so critical to patient care. Health care should be a human interaction between a patient and their physician rather than a business transaction between a consumer and a provider. Even the use of the word “provider” cheapens the role of the physician.

Two examples come to mind. The first was a patient with rheumatoid arthritis and marked anxiety. She was very aware of her anxiety and would often joke about it. She became one of my favorite patients. At one point, she developed subtle changes in leg strength that she thought might be related to her medication — or simply her anxiety. Her exam did, indeed, reveal subtle neurologic changes. Her MRI that night revealed a life-threatening subdural hematoma, which required emergency surgery.

Her diagnosis is not a testimony to my medical acumen. It is a testimony to the importance of the patient-physician relationship. Her life was saved, because I knew her baseline status so well. The importance of that patient-physician relationship should not be underestimated despite the growth of urgent cares and minute clinics.

My second patient was severely ill with vasculitis, a potentially life-threatening inflammation of blood vessels. Fortunately, he survived. Thereafter, his wife would often accompany him to office visits. We trained at the same gym, and I got to know him better. One day, he announced that he would be moving to Florida. His wife came with him to his last visit and said words that still bring tears to my eyes. She advised that the next time I get upset with all of the bureaucracy in health care, I should remember her husband and know that I make a difference not only in his life, but also in the lives of all the people who love him and still have him around.

Her words touched me and have been a source of inspiration in my career.

The single greatest joy in medicine is knowing that you have made a positive difference in someone’s life. In his novel The House of God, Samuel Shem writes that the most loving thing we can do as physicians is to “be with” the patient. We cannot always cure. We cannot always relieve suffering, but we can always “be with” the patient — that is, share their lives, commiserate in their sorrows, revel in their joys, and, most important, validate their experiences.

The caring may actually be more important than the curing. This is the “art” of medicine and is why the patient-physician relationship is the core of health care. There is no substitute.

The humanity in health care is being lost. We must not let that happen.

Mark Lopatin is a Philadelphia-area physician and the author of the new book “Rheum for Improvement: The Evolution of a Health-Care Advocate,” which addresses many of the issues that compromise the care that patients receive.

https://www.inquirer.com/health/expert-opinions/doctor-patient-relationship-insurance-prior-authorization-20220117.html

Dong Anker

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