Healing the Doctor-Patient Divide

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Healing the Doctor-Patient Divide

http://www.nytimes.com/2008/09/11/health/chen9-11.html?

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By PAULINE W. CHEN

" Patients and Doctors Start Talking. "

Those words, and the smell of grilled meats, wafted by me at a recent

potluck dinner party.

My husband and I had tagged along for a summer reunion, where my

sister-in-law and her husband joined a group of 40-, 50- and 60-

somethings who were visiting their hometown, eager to catch up on

their childhood buddies' lives.

The chatter started as one would expect -- five-minute recaps of

work, children, parents and summer plans. But as the evening

progressed, the gossamer conversations of this boomer crowd seemed to

spin into one thread: the state of one's health. Or our parents'

health. Or our children's health.

And no matter the specifics of each story, they all seemed to revolve

around one theme: that as a patient or the family of a patient, you

would feel at odds with the very people who were supposed to care:

the doctors.

Looking back on that night, I realize that the conversations in this

polite crowd might have taken a different bent if the guests had

known that one among them happened to be a surgeon. I also realize

that because I am a doctor it might have only seemed like everyone

was talking about health.

But I don't believe that the stories I heard that night are the

exception. In fact, I think they may be the norm.

More and more Americans feel disconnected from their doctors,

especially compared to a generation ago. And they certainly have less

confidence in the profession as a whole. In 1966, a Poll found

that almost three-quarters of Americans had " a great deal " of

confidence in their health care leaders. That number has steadily

dropped over the last four decades, so that today only slightly more

than a third feel the same way, the same poll shows.

I can't blame people for losing their confidence in medicine. My

mother-in-law has been in and out of hospitals for the past couple of

years. While a few of her doctors have been extraordinary, there have

also been enough mishaps and misinformation to make me cringe every

time the threat of another hospitalization looms.

Moreover, when her kids ask her which of her doctors is in charge, my

mother-in-law can rarely provide a name. At first my husband

speculated that his mother was suffering from memory loss. But he and

his sister have since learned that in-house doctors turn over so

frequently that even the most intact intellect can lose track.

I know there's a problem with the way medicine works these days, but

as a surgeon, I've also stood on the other side. I have felt my heart

drop when a patient whose new liver I struggled to sew into place

decides without telling me to stop taking immunosuppressive

medications. I have felt a pang in my chest when, still paying back

student loans 15 years after my last graduation ceremony, I can hear

a patient questioning not my therapeutic recommendation but my

financial motivation.

And I feel a great sadness for my profession and my patients when I

hear conversations like the ones I heard at that summer potluck.

When I started medical school 22 years ago, I believed that I could

have the kind of relationship with patients that I had had growing up

with my pediatrician. " Dr. Kirkland " unflinchingly jabbed

immunization needles into my arms, regularly tapped my hyper-

reflexive knees with a rubber hammer and pulled no punches when I,

the moody adolescent, sulked in his waiting room or stormed out of

his office.

But despite those difficult moments, I knew that ultimately we stood

together. These days I'm not sure many of us -- patient or doctor --

can say the same.

There is a tragic irony in the growing divide between us. We all want

the same thing: the best care possible. But we have lost the ability

to converse thoughtfully with one another. And because of that loss,

we can no longer discuss the meaning of illness, care, health and

policy in a way that is relevant to all of us.

My hope is that we can revive that conversation. Not in a clinic or

hospital room, but here on the Web. Many of the topics I discuss will

emerge from my experiences in and out of the operating room, or

reflect an ongoing policy debate or fascinating research finding.

Others, I hope, will spring from your comments and unique

perspectives.

It will be the shared insights from this online community, I believe,

that will begin to bridge the gap between patients and doctors and

remedy the disconnect.

It is difficult for any one of us to change today's health care

system, but there is one thing every one of us can do.

We can begin the conversation.

ine W. Chen, a liver transplant and liver cancer surgeon, is the

author of " Final Exam: A Surgeon's Reflections on Mortality " (Knopf,

2007; Vintage, 2008). This is the first of a regular online

column, " Doctor and Patient, " that will be appearing on Thursdays at

nytimes.com/health.