I remember when I used to have to book an appointment to see my doctor. There wouldn’t be any availability for at least a week; I would spend hours in the waiting room before being rushed through, having submitted to some sort of uncomfortable exam. I’d be given no time to think, let alone ask questions, and would exit, prescription for an expensive drug in hand, wondering if I even needed it.
Of course, that was before Dr. Google and Dr. Wikipedia hung their shingles online. Some of us can remember the days we looked to doctors for answers. It was the doctor who was the expert and who held the key to the mysteries of illness and health. It was the doctor who knew how to investigate physical symptoms and treat diseases.
But times have changed, and while some doctors nostalgically evoke these good old days of medicine – in essence resisting the changes that are destabilizing their powerful positions – many of us welcome the chance to be our own health expert. Now, we can take charge of ourselves and our symptoms, accessing information through search engines, chat rooms, or crowd sourcing.
A doctor’s nostalgia for earlier times is, however, also understandable. We’re facing huge changes to the health care system, changes that aren’t always for the better. Today, doctors are being forced to practice under huge constraints and questionable systemic improvements. Increasing control and scrutiny of doctors’ work comes as data machines produce evidence-based medicine guidelines to dictate best practice and the management of patients. Computers in the examination room distract doctors and intrude on the patient encounter, constraining independent decision-making. Administrators command doctors to document every step to ensure that proper procedure is being followed, and that the maximum return is acquired for each patient seen.
But while changes are inevitable and there is no turning back, surely there are still traditional aspects of medicine that are worth keeping, such as the very simple and often-forgotten question of “What ails you?” Today, we are in danger of forgetting to ask this question about the human narrative that is at the very heart of the patient-doctor encounter.
Efficiency improvements that focus on outcomes, interactions that are increasingly technology-driven, and self-management as the ultimate goal all pose a risk to this relationship and to the “placebo” aspects of care that can’t be analyzed, quantified, or outsourced to Google.
My nostalgia for a time when doctors listened, observed, and searched for the questions that elicits the patient story is not merely a longing for earlier times. Today, decision-making should occur in the context of a therapeutic relationship where the doctor acts as the advisor and not as an all-knowing expert. Patients want to be inspired and given the tools to become more responsible for their own health. In this era of patient-centered medicine, evidence can be used as guidelines to help individual patients, not as a prescription to conform. And mobile sensors and digital records can act as aids, not substitutes for practicing medicine. Finally doctors are still needed to help patients make sense of information, and its relevance to the patient’s experience, because Wikipedia isn’t always helpful (or the most accurate).
Technicians and online advice may provide short-term fixes, but it is this new form of therapeutic relationship that truly has the potential to make people healthy.
Photo: The Doctor is in Your Pocket, by Sarah Kaiser via Juhan Sonin