“Patients will not acquiesce to the ultimate alienation of being reduced to standardized objects. No one will accept for long being identified by their illness, as nothing but an assemblage of broken down biologic parts. Patients crave a partnership with their physicians who are as sensitive to their aching souls as to their malfunctioning anatomy. They yearn not for a tautly drafted business contract but for a covenant of trust between equals earned by the doctor while exercising the art of caring…Professor Bernard Lown’s musings from more than 50 years of medical practice could not have been put more candidly. That special patient-physician relationship once the hallmark of the patient-doctor encounter, is slowly but surely dissolving into its last remaining vestiges in the acidic vat of modernity.
"Medicine’s profound crisis, I believe, is only partially related to ballooning costs, for the problem is far deeper than economics. In my view, the basic reason is that medicine has lost its way, if not its soul. An unwritten covenant between doctor and patient, hallowed over several millennia, is being broken.” ~ Bernard Lown, MD, Professor Emeritus, Harvard Medical School, world-renown cardiologist and Nobel Peace Laureate, in The Lost Art of Healing, Ballantine Books, 1999.
Has modern medicine reached its zenith and is now meeting its hubris? Have we let progress and the Knowledge economy superseded our roles by being too complacent and unprepared?
Have we been too smug in our obsolete beliefs that we are untouchable, despite the relentless “barbarians at the gate”?
Is the tenacious clinging to our paternalistic and autocratic approach too passé in today’s world? Or, have our previously paternalistic approach and superior attitude given way wholesale to the hodge-podge demands of the client, the consumer, whose every whim we must now pander to, whether it is for their ultimate benefit or otherwise?
Are we over-investigating and/or over-treating our patients for their sole benefits or for our own vested interests? Are we driven by financial and personal interests when we advocate for their choice in the best therapeutic recourse, or are we covertly perhaps subconsciously fraudulent in reshaping their decisions toward our own ends?
Have we pandered to the fashionable fads of today’s factitious wants that we dabble more and more into alternative, anti-aging and aesthetic therapies?
Indeed, are we as doctors the sole and final arbiter of what’s right and good for health these days? Sadly, the answer must be a resounding ‘No’. In this day and age, doctors have been relegated to be only one of the many bit players of an ever-expanding quagmire of our evolving health care ecosystem, which encompasses more and more players and participants.
Have patient or consumer knowledge empowerment so radically overwhelmed our sensible yet equipoise authority on what is truly best for each and every different person?
Have we surrendered en mass our balanced and well-honed judgment to the stringent inflexibility of practice guidelines of the modern era?
Has our hitherto much-vaunted physician-patient relationship expired its last breath?
Has modern medicine crossed the proverbial Rubicon, and met its overweening self-destructing conqueror—that technological disburser of ‘equal’ and one-size-fits-all health care to everyone?
Has medical practice become too scientifically or technically reductionist to the point of being all science and no art at all? Has this cold and impersonal approach driven our patients away toward other more caring practitioners of alternative systems?
Has the practice of medicine become so standardized that the 5-minute assembly-line type of patient-doctor encounter will become the norm of the future?
Have we let third party payers dictate how and what we should or could do as physicians nowadays? Do we need ‘gate-keeping’ because we could no longer be trusted to be objective and not consumed with conflicts of self-interest?
Have we floundered in our role to help everyone in need of health care, without that need to be partial to economic realities?
Have we bartered our souls to the pharmaceutical medical industrial complex, so that we are at their beck and call, as modern day drug-pushers?
Or has modern medicine favoured inequitably the rich and the powerful and those with a bigger buying power?
Are we now so enamoured with our own personal importance and well-being that we have neglected the paramount interests of our raison d’étre, our patients?
Have we debased the shifting ethics of our profession and sold our souls to the god of Mammon and the overarching supremacy of the modern consumerist? Whither our roles and place as modern day physicians?
Surprisingly, although doctors have been besieged with relentless crises after crises, many school leaving students still wish to become doctors.
Our perennial woes—from too little remuneration, too much work, long backbreaking hours, extensively prolonged apprenticeship and training, compulsory national service, intemperate competition (from fellow doctors, unscrupulous but bloodthirsty retail pharmacists, sinsehs, bomohs, qi gong masters, Ayurvedic physicians, alternative pliers of dubious therapies, etc.), rising medico-legal litigation, unwanted supervision from nonphysician corporations and managed care organizations, insurers, and third party payers, may seem insurmountable and inescapable—but these do not seem to deter the steady stream of aspirants from wanting to join our teeming but beleaguered ranks…
Perception from the public has never been more challenging and negative, even sneeringly envious and distrustful. Yet, when asked pointedly which profession the public respects the most, physicians still manage to come out tops in most societies—perhaps because other professionals are deemed even more cynically ignoble.
Nonetheless, despite these many questions which should interest the thinking doctor, there remains that implicit noble precept and understated prestige which colours our profession, and emanates that subtle but wholesome whiff of sanity of what it still means to be a physician.
Shouldn’t we all try and recapture our souls so that modern medicine in its finest glory can be the best, the safest and the most beneficent to everyone—regardless of all secondary concerns—equitably accessible to all.
Let’s all ponder some moments to reignite that inner voice of why we chose to become physicians in the first instance, and let our forgotten art of healing emerge.
(MMA News Editorial, November 2005)