Saving the Patient from the System
We doctors must remember that at some point in our life we will walk in the shoes of our patients
It’s not easy being a patient in the US healthcare system. A lack of health insurance, a shortage of doctors and a fear of malpractice directly affect the ability of medical staff to serve their patients. Those who are far from the front lines do not understand what it’s like to be a doctor running two hours late because the system requires you to see an 82-year-old woman with 12 medical problems and 25 medications inside 15 minutes.
Some time ago, I took a year off from medical school to work on healthcare reform. I went to Washington DC, eager to learn how to change this flawed system. Ironically, I soon found myself navigating it as a patient rather than as a clinician.
What had been a dull ache in my left hip turned into back pain so unbearable that I could not sit in a chair. After a whirlwind of incorrect diagnoses, hours spent on the phone with insurance companies and countless MRIs, I was left in despair. I had shuttled around between countless doctors. I had worked weekends so that I could spend my days in waiting rooms that all looked the same. I was utterly disappointed in the profession I had so long admired.
In seeing the healthcare system at work, I saw how it didn’t work. I was the problem patient: the patient whose diagnosis is not black and white, but grey; the one whose pain isn’t visible in the way that a gaping wound or broken bone is.
The pressures of volume require doctors to rush through patients. It takes less time to order an MRI scan than to do a physical examination. Often, instead of attention, I was given a prescription – a consolation prize, so that at least I walked away with something tangible.
Eventually, I found a doctor who managed to practise the kind of medicine I aspire to every day. She took a thorough history and physical examination. She looked me in the eye and listened. She cared. To this day, she is still my doctor.
Now that I am a doctor myself, I would be lying if I said that I don’t sometimes feel hurried. Patients aren’t predictable. They don’t always fit neatly into an allotted slot. They may come into the office for a rash and just as they are walking out, say: “Oh, by the way, doc, I have this pain in my chest when I walk.” You can’t just let them go. Those are the days I stop looking at the clock and try to remember how frustrated I felt when I needed more than 15 minutes and they were trying to rush me out.
I think often about one of my patients from medical school. She was diagnosed with lung cancer and initially refused to seek treatment. We spent many hours together. When I asked her why she eventually decided to go ahead with chemo and surgery, she took my hand and told me that it was because I had been there to listen to her fears and to encourage her. As a medical student, I had all the time in the world to give her this. Now, as a busy resident, I constantly remind myself that I must pause and focus on the person whose life is drastically affected by how I care for him or her.
We doctors know all too well that the system does not make it easy to look on the patient as a person, rather than as a list of tasks to be completed. Our own interests as physicians are not always aligned with those of insurance companies, malpractice lawyers or politicians. We must remember that at some point in our life we will undoubtedly walk in the shoes of our patients. All of us will come to know exactly what it’s like to sit in that waiting room, only to leave with lingering concerns and unanswered questions.
Financial Times Weekend Magazine | August 5, 2011