Compassionate Service vs “Managed Healthcare”

On the Need to Apologize for a Profession’s Loss of Compassion

Recently, during most of my patient visits, I find myself apologizing for my profession. That the profession of medicine should even require an apology seems deeply troubling to me. For so many years, we physicians worked long hours, taking on incredible amounts of stress and giving up sleep, all in the service of our patients. Medicine was our “calling.” We were proud to be of service, and were rewarded with the love and gratitude of our patients.

But about twenty years ago, when medicine made the shift into “managed care,” our job description changed from “physician” to healthcare “provider.” Now, that apparently minor alteration may not seem much; it didn’t at the time. But, in retrospect, it heralded a profound change in the way we were viewed, both professionally and by our patients. You see, a “provider” is a nondescript term suggesting that “something” is given (that is, “provided”) by a physician to a patient. And what is “provided” has changed from the days when we gave of our time, of our selves, of our caring, and of our compassion.

Previously, we took the time to listen to our patients; we got to know them and their families, so that we could place their illnesses in context (which includes their emotional and spiritual context, as well). But with the advent of “managed care”—which my colleague, Dr. Norman Shealy, has aptly termed “mangled care”—my profession has lost all of that. Patient visits are now reduced to a timed 7-10 minutes and, in that short a time, the only thing that can be “given” is a prescription.

Over the ensuing years, it has become ever clearer that the needs of patients with chronic illnesses—and these represent the majority of my patients—are not being met. Don’t get me wrong: for acute conditions (which would include heart attacks, strokes, trauma, and infections), patients’ needs can be met beautifully. Our current system is custom-made for acute conditions. But when conditions are chronic (which would include arthritis, emphysema, fatigue, headaches, and diabetes), a short, assembly-line office visit is not adequate to the task.

For a variety of other conditions (including chronic Lyme disease, fibromyalgia, chronic fatigue, regressive autism, hypoglycemia and chronic intestinal yeast infections), conventional medicine does not believe that anything substantial can be done. For these, conventional medicine sends one of two messages to patients: either “learn to live with it,” or “it’s all in your head, so take these antidepressants and go home.”

On an almost daily basis, this is what I apologize for. I am embarrassed to see so many patients whose illnesses have been ignored by my colleagues, to the point that many of them are, indeed, depressed. And why not? Denied hope or compassion, who wouldn’t be depressed? The majority of patients that I see have been scarred by such assembly-line indifference. I believe that a vast majority of these patients can be helped, but this scarring—which my own profession has perpetrated through “mangled care”—further complicates the healing process.

So I apologize. I wish my profession would come to its senses and reclaim its centuries-old tradition of compassionate service. And I hope it comes to its senses soon, because there are millions of suffering individuals out there whose needs are not being met. Simply put, we must meet their needs.