Growing up, I never really thought about what it meant to be a doctor, even though it was a path I was destined to walk from an early age. I went to medical school, did an internal medicine residency and a rheumatology internship. Eventually, I joined private practice in 1992.
Everything was fine until 1999 when a frivolous lawsuit shattered my world. As a doctor, being sued for malpractice is very different from, say, a driver being sued for a car accident. It attacks your core identity. I was devastated. For various reasons, mostly fear, I settled the lawsuit, even though I knew I had done nothing wrong. I was filled with rage and became politically active for the first time in my life.
The original issue was tort reform, but over time I have become acutely aware of the many other health care issues that compromise a physician’s ability to provide appropriate care.
There are many examples. Prior authorization requirements from insurance companies who have never seen the patient lead to delays or denial of care. Excessive documentation demands mean doctors have less time to actually care for patients. Corporations promote policies that would allow those who do not have a medical license, medical degree, or medical training to practice medicine.
Those who seek to control the health care dollar have systematically devalued physicians and diminished the patient-physician relationship that is so essential to patient care. Health care should be a human interaction between patient and physician rather than a commercial transaction between consumer and provider. Even the use of the word “provider” belittles the role of the physician.
Two examples come to mind. The first was a patient with rheumatoid arthritis and marked anxiety. She was very aware of her anxiety and often joked about it. She has become one of my favorite patients. At one point, she developed subtle changes in leg strength that she thinks could be related to her medication – or just her anxiety. Her examination revealed subtle neurological changes. Her MRI that night revealed a life-threatening subdural hematoma, which required emergency surgery.
His diagnosis is not evidence of my medical sense. It is a testament to the importance of the patient-doctor relationship. His life was saved, because I knew his initial state so well. The importance of this patient-physician relationship should not be underestimated despite the growth of emergency care and quick clinics.
My second patient was seriously ill with vasculitis, a life-threatening inflammation of blood vessels. Fortunately, he survived. Thereafter, his wife often accompanied him on office visits. We trained in the same gym and I got to know him better. One day he announced that he would be moving to Florida. His wife came with him on his last visit and said words that still bring tears to my eyes. She told me that the next time I was upset with all the health care bureaucracy, I should remember her husband and know that I am making a difference not only in his life, but in the lives of all people who love him and who continue to have him around.
His words touched me and were a source of inspiration in my career.
The greatest joy in medicine is knowing that you have made a positive difference in someone’s life. In his novel The house of God, Samuel Shem writes that the most loving thing we can do as doctors is to “be with” the patient. You can’t always heal. We cannot always relieve suffering, but we can always “be with” the patient, that is to say, to share his life, to empathize with his sorrows, to revel in his joys and, above all, to validate his experiences.
Care may actually be more important than care. It is the “art” of medicine and it is why the patient-doctor relationship is at the heart of health care. There is no substitute.
Humanity in health care is being lost. We must not let this happen.
Mark Lopatin is a Philadelphia-area physician and the author of the new book, “Rheum for Improvement: The Evolution of a Health-Care Advocate,” which addresses many of the issues that compromise the care patients receive.