The Doctor Will See You-If You're Quick

Article excerpt

Byline: Shannon Brownlee

Feeling like your doctor is rushed, distracted, or just doesn't care? You're not alone, and it may be hurting your health and your pocketbook.

Four years ago a 38-year-old adjunct professor at American University named Fred Holliday began suffering from a variety of ailments: he was losing weight, his blood pressure went up. Then he cracked a rib. And he started suffering from debilitating back pain. Each time a new problem arose, the Washington, D.C., resident visited his doctor, who dealt with his symptoms piecemeal. First she prescribed blood-pressure medication. At another visit, she chalked up his fractured rib to violent coughing from a cold he had. Then she prescribed narcotics for his back. When his pain grew worse, she simply increased the dose of painkillers.

After months of this, Fred's wife, Regina, looked up his symptoms on the Web. Together, they pointed to kidney cancer. When the worried couple went back to the doctor, Regina recalls, she walked into the exam room, reading Fred's chart, and without looking up, asked, "Mr. Holliday, do you think you're depressed?" It was a routine question, based on the number of his complaints. Regina started laughing in disbelief. "Of course he was depressed," she says. "She wasn't taking care of him." At Regina's insistence, the doctor ordered an MRI, which showed that Fred had kidney cancer. He died about three months later.

These days, stories like the Hollidays' are cropping up all over, and while most don't have such tragic endings, they are signs that something in the world of medicine is seriously amiss. Unhappy patients gripe about their doctors' brusque manner and give them bad marks on surveys and consumer websites like HealthGrades and Angie's List. They tell tales of being rushed out of the office by harried doctors who miss crucial diagnoses, never look up from their computers during an exam, make errors in prescriptions, and just plain don't listen to their patients. Studies show a steep decline over the last three decades in patients' sense of satisfaction and the feeling their doctors are providing high-quality care. And things don't seem much better from the other side of the stethoscope. In a recent survey by Consumer Reports, 70 percent of doctors reported that since they began practicing medicine, the bond with their patients has eroded.

At the heart of the problem, say many doctors and policy experts, is the fraying of the doctor-patient relationship. And this is not just a question of touchy-feely good vibes: a growing body of research now points to the critical importance of having a connection to a trusted physician. "There is something in the human body that says we are hardwired to get better when we have a certain relationship," explains Howard Brody, a primary-care physician and director of the Institute for the Medical Humanities at the University of Texas Medical Branch, in Galveston. The good news is that doctoring may have hit rock bottom--and policymakers and physicians who have begun efforts to rebuild it realize that the only way out is up.

Anyone who is old enough to have watched Marcus Welby, M.D., the program about an avuncular doctor that was the most popular show on television in the 1960s, probably remembers his or her own family doctor with at least a measure of fondness. Back then, our doctors knew us and our ailments. They knew when our kids were born, how we felt about our jobs and our spouses, and whether or not we tended toward stoicism or malingering in the face of illness and pain. Today you're lucky if your doctor knows the correct pronunciation of your name, much less your medical history.

At least part of the blame began with the managed-care revolution of the 1980s and '90s, an initially well-meaning effort intended to improve the quality of medicine and control costs, but which ended up fracturing the doctor-patient bond. Many insurers focused more on cost at the expense of quality. …