Health care crisis affects both doctors, patients

Mark Tucker of St. Louis serves as the public member of the State Board of Registration for the Healing Arts in Missouri. The board, which comprises eight physicians and one voting public member, administers and executes the statutes, rules and regulations of the Healing Arts Practice Act.

There's no question that there's a crisis in health care today. But it's a different crisis depending upon whether you are on the care-giving or care-receiving side.

If you are a doctor or another health care provider, you are saddled by more patients, more paperwork, greater expenses, and declining insurance and Medicare reimbursements.

Throw in a permissive court system and a continuing loss of control to health maintenance organizations, insurance companies and the government, and the crisis appears to threaten the fundamental practice of medicine as we've known it.

But if you are a patient, the crisis looks quite different. It's a crisis of communications a shift from the fundamental and close doctor-patient relationship that we've long known, to what many patients now believe is a relationship that is increasingly impersonal and, perhaps, unsympathetic.

While doctors are worried about the number of patients they must see each day to break even, or the size of their malpractice insurance premiums, or the possibility of being overruled by the medical administrator of an HMO, patients are simply worried about their ability to talk to their doctors.

Many patients have come to expect long waits before callbacks, or no callback at all. Some are resigned to the fact that a third party will almost certainly screen their concerns.

Many worry that their diagnosis may come from a nurse, or even a secretary, or that they may have to wait days for test results.

And some patients, particularly older ones, are innately intimidated by their doctors.

For everyone who calls for minor problems, there is another hesitant to call at all, even for serious problems, for fear of "bothering the doctor." Or, they hesitate to ask important questions, concerned that they won't understand the rushed response.

What's crystal clear in this dual crisis is that patients have no idea how difficult it is to be a doctor these days, and doctors appear to be losing their sense of how difficult it is to be a patient.

On one hand, the public has always believed doctors are well paid, and they refuse to believe that today's economics are seriously challenging the profession.

On the other hand, the profession, beleaguered by its problems, seems to have forgotten what it's like to have that sense of desperation while waiting for test results, the frustration of needing professional advice immediately but not getting it, or the sense of personal dignity being challenged by the impersonal response of a nurse or a secretary who, the patient truly believes, doesn't understand and probably doesn't care.

So what's the answer? There is no silver bullet that will make either crisis go away immediately. But the first step has to be increased awareness from both parties about the other's plight.

The public needs to develop a better understanding of the dilemma facing today's medical professional. Medical associations need to do a better job of explaining the problems and the impact on medical care. The news media has to develop a better understanding of the issues and do its part to explain them to the public. And the public has to support political candidates and legislation that address the fundamental issues.

The profession also has to demonstrate better awareness.

It has to show more empathy for its patients. It has to improve communications and show that, on a personal side, medical professionals understand what patients are going through and that they care about patients.

We've made incredible progress over the last half-century in medical technology. We can see things, do things and fix things that we never imagined.

Now, perhaps, it is time to go back 50 years, see the kinds of doctor-patient relationships we had back then, and do what we can to make improvements in today's relationships.