The Unrealistic Expectations of the American Patient

What do patients hope to achieve when they go to see their doctor?  The simple answer is: a diagnosis and treatment.  However, their actual expectations may be a bit more complex and rooted in the evolution of the modern American healthcare system.

The physician has historically been a highly respected member of the community, classically making house-calls to sick patients with a briefcase of medical supplies so that a bedside clinical diagnosis could be attained.  As the American population grew, physicians began to see patients in their office to increase efficiency and allow for more office procedures (i.e. microbiology cultures, strep throat tests, and urinalysis) that would aid in diagnosis.  With insurance reimbursements declining over the recent decade, physicians have been forced to increase their efficiency even more to accommodate more “customers” in the same amount of time in order to afford their overhead costs (office staff, medical supplies, and office rent).  This general trend has led to strict time limitations on the patient-physician interaction and, unfortunately, increased dependence on and use of medical diagnostics (which do help the physician reach an appropriate diagnosis but also add to the reimbursements garnered from insurance companies for the visit).

Resource availability has dramatically changed over the past few decades.  Medical information used to be a “black box” for the general public.  Physicians may have been highly respected because they spent years training to learn and understand vast amounts of information that could be filtered and delivered to the patient when appropriate.  Medical literature was only contained within large textbooks that were expensive and usually only purchased and read by doctors.  Now, medical resources for the layperson are widely available on the internet and in medical literature specifically directed to the average citizen.  A patient is one “Google search” away from a host of websites waiting to diagnose them based on their symptoms.  Additionally, a diagnosis given to the patient by a physician oftentimes leads to an online search of the layman’s medical literature.  This can be both good and bad – empowering patients about their illness can be helpful, but all patients are different and their nuances may be part and parcel to their physician’s recommended treatment regimen.  Additionally, the “magic” of the doctor’s office becomes more transparent to the patient, which affects expectations.

The legal industry has preyed on doctors for decades.  Physicians are constantly dealing with life-or-death matters, and mistakes can be made.  Mistakes come from different places, though, and not all of them have secondary motives.  However, the legal industry has attacked physicians so fervently that it has affected practice patterns by many doctors.  Unnecessary tests and medications are often prescribed in an excessive manner because of trends created by litigation and can lead to unnecessary side effects and complications.  It also leads to an atmosphere of “doing” as opposed to “thinking” about patients.

What results from all of these changes is a culture of expectations that may not be serving our patients well.  Not all patients need that MRI that they end up getting for lower back pain.  Not all patients need antibiotics for the fever they developed yesterday.  Sometimes, the medical decisions that are made because of the complex interactions of the legal system, patient’s expectations, and the high-throughput nature of modern-day healthcare can lead to a population that is sicker now than ever before. Is that really what we want?

Doc Veritas

Tweet