Why a deteriorating doctor-patient relationship should worry us

If there is a single profound thing that has occurred in health care over the past couple of decades, that has neither benefitted patients or the doctors who care for them, nor the health system as a whole, it is the fairly rapid deterioration of the physician-patient relationship as the centerpiece of effective, satisfying, and high quality health care delivery. Instead of building system improvements around strengthening the relational care between our best trained health care professionals and patients, many health care systems around the world have chosen to place their faith in technologies like electronic medical records, which surveys show makes the doctor’s ability to connect with the patient and spend time with them as an individual more challenging and frustrating. In addition, the industry’s growing corporate takeover of health care delivery, driven by large health systems, insurance plans, and hospitals place the health care organization, not the individual doctor, in front of the patient at every turn. As a result, patients become “consumers”, and the role of the doctor in being the patient’s trusted ally shrinks.

That ongoing doctor-patient relationships built on high levels of trust, empathy, mutual respect, active listening, and expert guidance produce positive benefits is indisputable. These types of relationships are dyadic, interpersonal, and best nurtured through ongoing face-to-face contact between physician and patient. They are organically constructed and maintained, through a commitment by both parties to the relationship that each matters to the other, and behavior on both sides that demonstrate that commitment and the personal accountability that comes with it. If one examines the medical literature over decades, it is clear that these features of strong doctor-patient relationships favorably impact various health outcomes, patient satisfaction, patient compliance and commitment to self-management, and physician satisfaction and burnout.

Doctors benefit immensely from experiencing vibrant relationships with their patients. In survey after survey, physicians state that the most important and satisfying aspect of their jobs is the relationships they can have with their patients, and the intellectual and psychological stimulation that comes from knowing who they are, what they want and need, and perhaps how to get it to them. These same surveys show rising levels of job dissatisfaction, career regret, and burnout—and it should be no secret to assume that these negative outcomes are in part due to doctors experiencing less and less of the relational depth with their patients they so desire. Patients also know the personal value of connecting with a particular physician, and establishing a rapport and level of trust with them over time. We need health care often at the most vulnerable times in our lives, when we are filled with uncertainty and fear. The opportunity for us to share our thoughts and emotions with doctors, to have them hear us out and offer guidance based on who we are as unique human beings, and help us make important decisions about our health depends directly on having someone well-trained and accessible to believe in and trust.

Increasingly, though, the health care delivery system pushes a cheapened version of transactional care at the expense of doing things to strengthen this relational bond between doctor and patient. It commodifies health care services at every turn, creating buying and selling opportunities to push new, often unproven treatments and products onto patients for the sake of profit rather than quality of care; markets the illusory features of “company brand” to gain patient loyalties as if we were in the health care market for automobiles, televisions, or smartphones rather than improved well-being and emotional support; standardizes care delivery in ways that treat all patients as exactly the same in terms of needs and wants; and then seeks to have us believe that things like convenience and ease of access, while important and necessary in their own rights, are really the most important things we want from our health care delivery system.

Lasting damage is being done to the doctor-patient relationship because of these actions, and the corporate philosophy which sees health care as the next vast retail marketplace from which new types of profits can be squeezed. For example, my own interactions with the health care delivery system now feel impersonal, rushed, fragmented, and devoid of human feel. I am never able to see my “regular” primary care doctor, and every access point into the system is barricaded by a maze of phone systems, complex directions for how to seek out care, and poorly paid and motivated staff. The “convenience” I get is often a superficial and incomplete service or product that is only good for the most basic of my health care needs. In the meantime, I am told repeatedly how much the quality of my “experience” matters to insurance plans, medical offices, and hospitals, even as that experience involves bonding with or even seeing a given doctor less and less.

These experiences are not unique. I have interviewed patients and talked with friends and family members, and such experiences are increasingly typical of the system in which we find ourselves. Certainly, there may have never been a time when all doctors and all patients had deep, personally satisfying therapeutic relationships, the kinds that allowed unseen problems to be discovered and patients to share personal and deeply emotional aspects of their lives with their doctors. But what is being thrust upon us now is a greatly diminished version of the relational depth many doctors and patients experienced in the past.

It should worry us all, because if it is not recognized and meaningfully addressed soon by the industry, our children will grow up never knowing what their health care system and its most highly trained professionals could do for them.

Featured image credit: Hospital. CC0 Public domain via Pixabay.