The doctor/patient relationship: What have we lost?

Consider how the meaning of the word "personal" has changed when applied to medicine. Today "personalized" medicine does not mean time for the doctor to better understand the individual patient. It means using more technology. The definition of "personalized medicine" in the 2007 Senate bill is "the application of genomic and molecular data to better target the delivery of healthcare, facilitate the discovery and clinical testing of new products, and help determine a person's predisposition to a particular disease or condition."

We can never return to a simpler, slower, less technological past, nor would we want to. Cancer vaccines, genomic sequencing, and stem cell research will lengthen our lives and improve the quality of our days. I'm not convinced, however, that the modern doctor/patient relationship is progress. Medicine is still about healing, and listening to the patient remains a highly therapeutic process.

Hiding in clinical foxholes, far from the essence of the patient

I recently came across a story from Dr. Paul Rousseau, whose email address is "palliativedoctor." He advises patients and their families on end-of-life care. He discussed a woman, Mrs. Albersmith, who was ready to die. She had an advance directive, the quality of her life had become unacceptable to her, and her family was in agreement.

Dr. Rousseau spent time talking to Mrs. Albersmith's sons, grandson, and husband. Not only did he ask about his patient's life, but he asked about her husband. He was amazed to learn that this man had helped develop the GPS system for the military and that William Buckley had wanted to purchase one his sculptures. Speaking to other doctors, he comments:

As I bid Mrs. Albersmith and her family good-bye, ... I wondered how often a physician fails to understand the value and importance of a family member, especially a husband or wife, especially at the end of life. This person is an integral part of the patient's personal, cultural, and spiritual makeup, and his or her history helps to develop a clinical portrait of the patient's values and beliefs. ... Unfortunately, I believe such clinical absences - the failure to acknowledge and to collect the history of a close loved one/caregiver - occur more often than not. ...

It seems that we physicians have strayed from the bio-psychosocial model of patient care as well as the humane and personal touch that is so essential to healing and instead have chosen to hide in clinical foxholes where CT scans, laboratory data, and mundane and tangential information is discussed, far far from the bedside, and far far from the essence of the patient.

Related posts:
Doctors in the trenches speak out - Part two
Contempt and compassion: The noncompliant patient