Dear doctor, we’ve lost our faith in medicine

[Guest guest]

Dear doctor, we've lost our faith in medicine

What can be done to repair the crumbling doctor-patient relationship?

By Tara -Pope

http://www.msnbc.msn.com/id/25890068/

A growing chorus of discontent suggests that the once-revered doctor-

patient relationship is on the rocks.

The relationship is the cornerstone of the medical system — nobody

can be helped if doctors and patients aren't getting along. But

increasingly, research and anecdotal reports suggest that many

patients don't trust doctors.

About one in four patients feel that their physicians sometimes

expose them to unnecessary risk, according to data from a s

Hopkins study published this year in the journal Medicine. And two

recent studies show that whether patients trust a doctor strongly

influences whether they take their medication.

The distrust and animosity between doctors and patients has shown up

in a variety of places. In bookstores, there is now a genre of " what

your doctor won't tell you " books promising previously withheld

information on everything from weight loss to heart disease.

The Internet is bristling with frustrated comments from patients. On

The New York Times's Well blog recently, a reader named Tom echoed

the concerns of many about doctors. " I, as patient, say stop acting

like you know everything, " he wrote. " Admit it, and we patients may

stop distrusting your quick off-the-line, glib diagnosis. "

Doctors say they are not surprised. " It's been striking to me since I

went into practice how unhappy patients are and, frankly, how

mistreated patients are, " said Dr. Sandeep Jauhar, director of the

heart failure program at Long Island Jewish Medical Center and an

occasional contributor to Science Times.

He recounted a conversation he had last week with a patient who had

been transferred to his hospital. " I said, `So why are you here?' He

said: `I have no idea. They just transferred me.'

" Nobody is talking to the patients, " Dr. Jauhar went on. " Everyone is

so rushed. I don't think the doctors are bad people — they are just

working in a broken system. "

The reasons for all this frustration are complex. Doctors, facing

declining reimbursements and higher costs, have only minutes to spend

with each patient. News reports about medical errors and drug

industry influence have increased patients' distrust. And the rise of

direct-to-consumer drug advertising and medical Web sites have taught

patients to research their own medical issues and made them more

skeptical and inquisitive.

" Doctors used to be the only source for information on medical

problems and what to do, but now our knowledge is demystified, " said

Dr. Lamberts, an internal medicine physician and medical

blogger in Augusta, Ga. " When patients come in with preconceived

ideas about what we should do, they do get perturbed at us for not

listening. I do my best to explain why I do what I do, but some

people are not satisfied until we do what they want. "

Others say the problem also stems from a grueling training system

that removes doctors from the world patients live in.

" By the time you're done with your training, you feel, in many ways,

that you are as far as you could possibly be from the very people

you've set out to help, " said Dr. ine Chen, most recently a liver

transplant surgeon at the University of California, Los Angeles, and

the author of " Final Exam: A Surgeon's Reflections on Mortality "

(Knopf, 2007). " We don't even talk the same language anymore. "

Dr. H. Newman, an emergency room physician at St. Luke's-

Roosevelt Hospital Center in Manhattan, says there is a disconnect

between the way doctors and patients view medicine. Doctors are

trained to diagnose disease and treat it, he said, while " patients

are interested in being tended to and being listened to and being

well. "

Dr. Newman, author of the new book " Hippocrates' Shadow: Secrets from

the House of Medicine " (Scribner), says studies of the placebo effect

suggest that Hippocrates was right when he claimed that faith in

physicians can help healing. " It adds misery and suffering to any

condition to not have a source of care that you trust, " Dr. Newman

said.

But these doctors say the situation is not hopeless. Patients who

don't trust their doctor should look for a new one, but they may be

able to improve existing relationships by being more open and

communicative.

Go to a doctor's visit with written questions so you don't forget to

ask what's important to you. If a doctor starts to rush out of the

room, stop him or her by saying, " Doctor, I still have some

questions. " Patients who are open with their doctors about their

feelings and fears will often get the same level of openness in

return.

" All of us, the patients and the doctors, ultimately want the same

thing, " Dr. Chen said. " But we see ourselves on opposite sides of a

divide. There is this sense that we're facing off with each other and

we're not working together. It's a tragedy. "