Sunday, March 05, 2006


The medical system in this country is broken. There is not a doctor in the United States today who does not believe that this is so. Beset on all sides with increasing demands and decreasing resources, the practice of medicine has become grim indeed. Pressured by increasing paperwork and productivity requirements, decreasing reimbursements and a fixed number of hours in the day, doctors are struggling to provide quality care.

There is another fundamental way in which the American medical system is broken, however, and that way is completely under the control of physicians. The American medical system no longer treats patients with respect. Patients are routinely forced to wait absurd amounts of time in emergency rooms and doctor’s offices. They receive inadequate information about illnesses, and precious little information about alternative medical options. Patients in pain are routinely under treated, forced to wait, and to beg for adequate pain medication.

In a way, this is not surprising. Patient comfort has never been a priority in the delivery of medical care. During my internship and residency some 20 odd years ago, I was yelled at every day and in every way by my superiors. I was chastised for a million reasons, large and small, important and petty. Yet I was never yelled at for the way I treated the patients.

I tried my best to treat patients respectfully, but it didn’t matter if I did so or not. No one cared how the patients were treated as long as I, personally, didn’t kill them. I could wake them whenever I wanted, make them wait for me for as long as I wanted, and treat them inadequately for pain. No one else was the least bit concerned.

As outside pressures on the medical system have mounted, the situation has only gotten worse. The fact is, though, that it is entirely within the power of doctors to change this situation. It does not cost time or money to treat patients with respect. It only requires making it a priority for each of us individually and for the profession as a whole.

This will require a change in attitude though and medicine is not noted for its willingness to change. The most profound change in attitude in the profession comes from within my own specialty, obstetrics. Fifty years ago, women routinely gave birth in stirrups, over medicated and without husbands at their sides. This has completely changed. What happened?

Traditional obstetric practice was never medically necessary. When women began requesting changes, doctors reflexively refused. Yet as more women continued to ask, doctors began to wonder why they were refusing. There was no reason not to let husbands in the delivery room, for example; doctors could not justify it to themselves and so they relented. The process of birth was enhanced for everyone: mothers, fathers and physicians themselves.

The purpose of this blog is to raise the same kinds of questions. Why do we treat the patients the way we do? Is it justified? And if not, how are we, as physicians, going to change?


Blogger Trauma One said...

Interesting blog. You make a lot of great points. Not every physician thinks the system is broken, although that is exactly how I felt several months ago. I've come to a different observation. I think it is evolving. I won't bore you with the details, but if you are interested checkout:
It's a bit off the beaten path, but one I hope to develop into a more optimistic vision of the future of healthcare.

7:25 PM  
Blogger Tom Ferguson, MD said...

Hi, Amy,

I like your blog a lot! It's nice to see such a frank and open critique of the routinely humiliating (or at the very least, unconsciously neglectful) ways in which many of our colleagues, even some of the most well-meaning, sometimes treat their patients.

I'm a member of an informal little band of docs & patients trying to make a difference by emphasizing the promise and potential of our first generation of e-patients. One of our projects addresses exactly the sort of problem you describe through an almost absurdly simple but remarkably effective system of patient feedback.

You can find some of our group’s thinking and work by searching on "e-patients," & also at and

We're looking to build a network of like-minded advocates for effective but convivial healthcare reform, and you sound like just our sort of person.

If you'd be interested in hearing more about what we're up to, please e-mail me at

Warm wishes,

--Tom F

6:15 PM  
Blogger Waldo Jaquith said...

Funny, I just posted about just such an interaction on my blog a few days ago. The point of it is that the doctor is probably quite talented, but also really rude. Ironically, and foolishly, I think I'd be happier going to a less capable doctor if s/he was nicer.

11:18 AM  

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