The is the second installment by Dr. Smith discussing the changing landscape of medical. The first installment can be found here.
In my last article, I alluded to how medical care is changing at near warp speed, as the volume of new knowledge keeps doubling every few years or less. There’s a load of good treatment and care, as well as improved outcomes that comes from that. At the same time, there are some downsides to the changes in medical care that I believe should be resisted when possible. One downside is that the default drift of our medical care is to become steadily less personalized, less relational.
Consider the family doctor of past decades who would often help deliver the children, see them when they were sick, watch them as they grew up, do home visits when needed, and be present when death came. They knew the families well and could administer care in very reassuring and intimate ways. Of course, they often averaged only a few patients a day, had a low overhead, needed only minimal, if any, staff and had an exponentially smaller amount of medical facts to digest. That is not in the least to diminish them; they were often brilliant, sacrificial, intensely devoted persons administering the most effective treatments of their time in a deeply personal manner. But going back to that kind of practice with today’s medical realities and costs is probably not practical.
Continuing forward to my three decades of medical care, the depersonalization of medical care has continued apace. I have watched the trend rather regretfully and most patients have been the poorer for it. So, what are the driving forces for this depersonalization of care? In my opinion there are several: One is the smothering blanket of bureaucratic requirements that sucks more and more time away from the patient-doctor interaction. Another force is the fragmentation of care. Patients receive care from so many different doctors, walk-in clinics, specialists and non-physician providers that no one care-provider is likely to really know the patient in the way a physician of bygone decades would have.
Another driver toward depersonalization is the huge financial overhead that pushes a typical practice to see more patients, shrinking down a typical visit to a few pressured minutes. Add to that the loss of physician/patient control of medical care brought about by the insurance-driven model of medical care. With insurance typically collecting and then distributing the money in this system, they increasingly assume the power to decide what gets done, what the payment will be, who you can see (and that might change year to year) and what diagnostic and treatment options will be withheld.
In spite of all this, I love what I do. But, at the same time, these forces, and probably many I haven’t mentioned, have threatened to sap away much of the blessing of providing personal, relational medical care. My intent isn’t to be negative, but only to point out some of these forces with the hope of battling to preserve personal medical care.
Of course, no one is obligated to follow my suggestions. But as a participant in medical care over three decades, my hope would be that many would:
- Promote the right of patients and their physicians to direct medical care, not insurance companies and government agencies.
- Consider joining one of the cost-sharing ministries to cover your major costs and then budgeting for your own basic primary care, perhaps through a direct primary care arrangement with your doctor, so that the financial power stays in your hands.
- If possible, consistently see your own physician for your standard medical care so that you stay connected and a level of personal relationship develops that enhances your medical care.
- Support policies that reduce bureaucratic burdens that suck away the time and attention of your physicians from actual personal care.
This is a topic that is close to my heart, but impossible to cover in the scope of a brief article. Still, maybe this can stimulate a little of your own thoughts and ideas; maybe in some small ways we can, together, battle to keep the human touch, the focused personal connection of medical care. Personally, I hope so.
Andrew Smith, MD is board-certified in Family Medicine and practices at 2217 East Lamar Alexander Parkway, Maryville. He is contracted with some commercial insurance carriers and sees Direct Primary Care patients who do not have insurance, who belong to a cost sharing ministry, or who are on Medicare. He is accepting new patients. You may contact him at 982-0835