What really happens when doctors fail, and big healthcare corporations “too big to fail” place their own interests above that of their patients?
Zachary Meisel and Jesse Pines in their astute article called Why People Overuse the E.R; The Allure of the One-Stop Shop say that the commonly held belief that (as doctors may see it) hypochondriacal patients are to blame for astronomical healthcare costs in this country is largely a myth, and that it is the system, not the patient that is to blame for the number of patients needing to go to the emergency room and associated costs.
Nowadays most physicians’ offices’ voicemails and phone systems will tell you to hang up and call 911 when rapidly worsening medical problems aren’t diagnosed and treated in a timely manner due to the slowness of many health systems, especially in large University Hospitals such as Emory Healthcare in Georgia, where most of my doctors work.
In Emergency Medicine doctors are often trained cynically and lump patients presenting in the ER that don’t fit into an easy and neat diagnostic box into an “other” category that is usually assumed “faux”, “functional”, or worse yet, assumed “feigning” and attributed either to a mental illness or some tertiary or secondary gain. At that point of triage the human in bed #3 ceases to be regarded a human being anymore and his/her suffering ignored, sometimes quite willfully by one or more on the healthcare team. Such a patient’s very credibility is placed in question, and the system seems to operate on a different set of principles than it would for most patients assumed worthy of having their suffering alleviated, treated as honest individuals, listened to and taken seriously.
This mentality sets the scene for abuse and neglect, and whomever is in charge either by active or passive complicity perpetuates this negative approach in the orders given (or not given), the way they instruct nurses and speak with the other physicians, and their level of empathy (or lack thereof) conveyed to patient and co-workers.
Few doctors have both inpatient and outpatient privileges anymore, so that non-continuity-of-care compounds the problem when hospitalization is indicated but a direct admission is hard to facilitate.
Snap judgments are made about a patient an ER doctor sees for a few minutes, and often those judgments are wrong, and can in the worst case scenario be highly detrimental to their receiving compassionate, respectful care, and thus they are stripped of their dignity.
Add to that the pressures of conformity endemic in large healthcare systems, and the interdependence of employees who work together on a daily basis and you end up with the perfect storm of medical error, bias, self-interest, and an environment ripe for the sacrifice of patients.
Not only do individuals need to be held accountable for their actions (or non-actions), but the systemic failures must be addressed and corrected.
From a sociological perspective it is not only the patient who must heal, but the healthcare system which must evolve a kinder, gentler approach; one in which patients are regarded as equal partners in their treatment. Much of medicine remains steeped in antiquity, even as research continues to replace long-entrenched ideas, many of them incorrect and destructive.
Most doctors, nurses, and others working in direct patient care don’t read the latest research. They may not have the time, energy, and in some instances aren’t interested, failing to see the relevance.
Many patients in their quest to help themselves to obtain the best and most appropriate care must read this research themselves because doctors don’t or won’t themselves. This in itself is often misinterpreted as hypochondriacal behavior as it has been taught in traditional medical training, but medical professionals are badly in need of a revision in this thinking.
It is a different world now, and today’s patient, especially the complex patient, must be educated and accepted as an equal partner in their treatment.
Communication and the open exchange of ideas is an essential component to promote and maintain a healthy doctor/patient relationship, and when that breaks down, trust also breaks down, making progress impossible.
There is no place for deception, trickery, and evasiveness, nor overbearing confrontation of the patient in a healthy doctor/patient relationship, even one that consists of a one-time consultation, and while doctors have the power of the pen and prescription pad, it must be acknowledged that in today’s world the doctor’s role is no longer that of ultimate authoritarian nor gatekeeper, but instead that of consultant to the patient.
The patient may choose to take the advice, or take it with a grain of salt, as in the final analysis the patient owns their own body.
A doctor should always be an ally, and if he cannot be then it is the duty of that doctor just to recuse himself and walk away without causing harm.
To negate this basic truth is to dishonor the patient and is by definition destructive and in direct opposition to the very concept of healing. The field of Medicine is a human service profession. The moment it becomes anything other than that in its practice is the day a doctor need not be in practice.