Repairing Healthcare Means Investing in the Patient- Doctor Relationship
Vicki Rackner MD

The American Cancer Society recently changed its breast cancer screening recommendations; breast-self-exam, the tool carefully integrated into health maintenance, is now “optional”. Now the question, "Will I continue breast-self-exams?" joins other two other questions women have been asking frequently this past year… "Should I stop taking hormone replacement therapy?" and "Do I get mammograms and how frequently?"

What is a woman supposed to do with the morning medical news she consumes with her coffee? Can she trust the new information? Will her physician have the time to sort it out with her? Will she feel comfortable asking for the extra time and attention, knowing her doctor is busy? Is this something she can look up on the Internet, and if so, where? Where is the trusted patient-doctor relationship when you need it?

The doctor-patient relationship is vital when patients translate medical information into real personal choices. There are no “right choices” when you're a patient…there's the choice that's best for you. You weigh your perception of the risks and benefits of doing A vs. doing B vs. doing nothing. Your physician and other healthcare professionals can be your guide to your best medical choice.

Your doctor can interpret what “breaking medical news” means to you. Clinical studies tell you what happens with groups of people. They don't tell you what you want to know… what will happen to you. The use of breast self exam (BSE) in screening for breast cancer is a case in point. A large study in China did not find differences in the death rate from breast cancer between a group of women who performed regular BSE and those who did not. I am a surgeon and about 80% of the women who were referred to me for breast masses found the lump themselves. I'm sure that these women, who may well have saved their own lives, are surprised by the recent change in breast cancer screening recommendations. Could there be a group of women like my patients in whom BSE makes a difference? Absolutely. Are you in that group? That's the million dollar question.

The recognition of the importance of the doctor-patient relationship is demonstrated in the ever-more-common “concierge” medical practice in which patients pay a monthly fee to have access to their physician. In essence patients are paying extra for the quality of care they enjoyed 30 years ago. My own primary care physician, after much soul-searching chose to join a concierge practice. She wants to connect with her patients in a way the system no longer supports. One of her “concierge” patients is a hard-working janitor with a low income, but pays the monthly fees because good medical care has high value to her.

I wear the hat of both physician and patient. From both sides of the exam table I conclude the most powerful therapeutic tool we have is the doctor-patient relationship. About patients feeling that a trusted, caring professional hears them and touches them. The healthcare crisis reflects the erosion of this relationship. Doctors just don't have enough time with patients. Sorting through the questions to find the best answer takes time and physicians are in large part employees who are not in control of their schedules or duration of clinic visits. New diagnostic tests replace the emphasis on the laying-on-of-hands physical exam. The CAT scan can detect a lung cancer that cannot be identified by a doctor and a stethoscope, but the cold hard table of the scanner cannot replace the warmth of the examining fingers of the doctor. Maybe the latex glove that covers this warm hand reflects the distance between healthcare provider and patient. Maybe it's a contributing cause. Some say the doctor-patient relationship activates our innate healing…the force that heals a skinned knee or a cut finger, even in the absence of a Mommy kiss. Any Mommy will tell you the kiss has magical power.

No matter which hat you wear in the healthcare story…patient, employer, physician, patient's loved one..you benefit from an investment in the patient-doctor relationship. Let's shore up the crumbling foundation of the healthcare system; let's put trust and caring back into the healing relationship between patient and doctor.