Trust

I have been having long, thoughtful conversations with family and friends about the dysfunction of the medical system in this country. In the last 10 years, I have personally seen the deterioration. Corporatization of medical practice has taken away much of the autonomy and joy of being a physician. Patients change insurance providers frequently, and are given different lists of clinicians to see. Continuity of care, and the long, incremental development of a good doctor- patient relationship is being lost. The Covid era exacerbated all these problems, when physicians became less available, and where all sorts of non-scientific treatments were espoused. Although this was a problem at the start of the HIV/AIDS pandemic, patients were more likely to trust scientific data, and breakthroughs in treatment greatly extended the lives of those with this diagnosis. Somehow, the development of the Covid mRNA vaccine in a year, with the resulting saving of millions of lives worldwide, is viewed much more skeptically. There is somehow now a sense among many in the MAHA community that mRNA vaccines are dangerous. HHS has withdrawn research dollars from mRNA vaccine development, which can benefit the treatment of both infectious diseases and cancers.

There have been wonderful technological advances during the past 40 years of my medical life. The electronic health record, which started in fits and starts and inefficiencies, is now a more powerful and interoperable tool. I can look at my patient charts from home, and study lab and imaging results more comprehensively on patients with difficult and unknown diagnoses.

I can read articles on conditions, and get current data on studies and medications. I can look at images digitally, and correspond with patients electronically.

Advances in treatments have yielded better outcomes, especially in the fields of oncology and infectious diseases.

But for all of that, patients are dismayed by their lack of contact with their clinicians. They are afforded only a few minutes to discuss their problems. They distrust the system, and their doctors.

Physicians, for their part, are overworked and burning out. They feel at a loss to convey medical and scientific data to patients who do not have basic science education. Patients resort to anecdotal social media. They spend wasted dollars on ineffective over the counter vitamins and supplements. They do not understand the difference between correlation and causation.

There is a great deal of frustration on the part of both physicians and patients.

At the basic level, there is a lack of trust in medical science. This is unfortunate and counterproductive. As a society, we depend on experts for everything we do: from the cars we drive, to the construction of our houses, to electrification. We need to depend on expert medical advice.

We need to trust our physicians. But physicians need to be there for patients over the long term. Trust comes from having a good relationship with our patients. They need to know that we are on their side, and that we take our Hippocratic Oaths seriously. This is very difficult to have in our current environment. We have lost a lot when we have demolished our small, independent practices. Medical care is too big, and too impersonal. In the final analysis, patients want a caring and competent physician who knows them well and who they can trust. Diagnoses of complex problems do not come from abbreviated visits to the emergency room, or to the merry go round of specialists that patients see. Patients need the warmth and familiarity of an internist or other primary care physician. A physician who knows them, and their families. The machine will not, and should not, replace that.