In recent years, some of healthcare has become more of an industrial, technician-oriented, conveyor belt model. The “glory days” (many of which weren’t so glorious) of gentleman doctors and their code of honor are definitely a thing of the past.
In some ways, the new world order — more democratic, more distributed across a team — in medicine works well. It helps contain costs. More providers across the continuum of care are able to make decisions and care for patients. People are able to be great doctors and have a sane personal life.
But sometimes we are reminded that there is something timeless and sacred about the relationship between a doctor and a patient. And that may just be something we need to honor more in today’s healthcare environment.
There is something timeless and sacred about the relationship between a doctor and a patient. There is also a sacred and unique relationship between a nurse and his patient; and between a caregiver or aide and her patient. They are all equally valuable, but the nature of each relationship is different. And there is something unique about the quiet, hallowed space between a doctor and the patients they have the ultimate responsibility to care for.
But in the ever-growing pursuit of a more democratic but also more “factory-style” medical system, healthcare has tried to gloss over the importance and primacy of that relationship. It’s tempting to argue that you can spread care out between an aide, a nurse, a Nurse Practitioner, with little “star appearances” by a doctor — and that nothing is lost. Or, similarly, that you can have a doctor provide telehealth in 4-minute video calls with people across the country… and that nothing is lost.
I think that the real risks and downsides of this approach becomes brutally clear in the most extreme care situations. For instance, dramatic news stories have come up recently that, in one way or another, touch on the role of the doctor as ally, guide, leader, and healer — not just as a technician. For instance:
- Maine has become the eighth state in the country to legalize physician aid-in-dying, and although the AMA opposes the decision, they insist it could be ethical for a doctor to assist a patient in dying.
- Doctors tend to feel responsible to go to more extreme treatment lengths at the end of life, if the patient leaves that decision entirely up to them.
- The new ECMO "miracle machine" saves lives but leaves patients in limbo, prompting serious ethical quandaries for doctors and for their patients.
- The American Medical Association is now even suing states, insisting that abortions should be the result of a decision between a doctor and her patient.
These are all hot-button issues. And politically or ethically, you may have strong opinions about them. My point isn't which side you fall on each of these. My point is that in each situation, there is an extreme responsibility that the doctor has to collaborate with his/her patient and make a decision that is truly life or death. They're not situations where you can simply follow protocol. They're not situations where there's a single right answer. And they're not situations where a doctor can make a unilateral decision without truly understanding the patient and the patient's family.
The truth is that, just as was true 200 years ago, doctors today have a grave responsibility to understand their patient — and act (as well as lead the patient to act) in a way that is truly in the patient's service. I believe that even as we keep an eye on costs, efficiencies, and teams — it's also fundamentally important that we honor the seriousness of the decisions that providers make with their patients. And that we support them — practically and emotionally -- in making them. That's where the role of medical collaboration comes in. It's not about 5-minute telemedicine videoconferencing. It's about helping doctors (and others across the continuum of care) in getting the collaboration and support they need to make the life-or-death decisions that they must make.