By Mark Stafford, M.D.
Professor, UAB Department of Medicine
Within the body of medicine, the doctor-patient relationship is the heart that allows the profession to survive. Never in our history has this relationship been under greater attack. Increasing administrative pressures force us to document all our interactions in detail. Dwindling reimbursement policies reward us for performing procedures on patients instead of talking with them. The threat of malpractice litigation fuels unproductive defensive medicine. Each of these issues has caught physicians in a stranglehold that threatens to cut off the connection we have with our patients.
Nevertheless, the future holds great promise. While I am one of a growing number of UAB physicians who currently use the university’s “Communicator” Internet portal to correspond with patients, soon video-mail will allow even greater access without physical office visits. The Internet will be a place doctors and patients meet on a more level playing field for the latest medical knowledge. But whether through video or skin-to-skin encounters, the heart of a meaningful and productive doctor-patient relationship will be unchanged: compassionately attending our patients while keeping the person in focus.
Legacy of Listening
During my UAB internal medicine residency from 1978 to 1981, Tom James, M.D., and Claude Bennett, M.D., developed the budding field of academic primary care. Alwyn Shugerman, M.D., founded the program at UAB and recruited the “young Turks,” Julian Byrd, M.D., and Stephen Cohen Cole, M.D., to teach the fundamentals of the doctor-patient relationship. They employed the new bio-psycho-social paradigm of communication for their approach—and it was a daring one. At a time when research and specialization had reached their ascendancy, talk of empathy and active listening usually drew barbs such as “touchy-feely” from my attending physicians and peers. Paradoxically, UAB’s cornerstone of success, Tinsley Randolph Harrison, M.D., embodied the sanctity of these principles in his research, patient care, and teaching.
Treating the Whole Patient
Today, the containment of health-care costs has become our national obsession. The Obama administration, coming full circle, now sees primary care and strong doctor-patient relationships as the pillars of our salvation. It faces a major challenge: Last year, the lowest number of trainees ever chose to practice primary care.
As we face interesting times, I hope medicine and primary care will see this as a window of opportunity to reinvigorate the doctor-patient relationship with a renewed emphasis on treating the whole patient. In our global village, my waiting room swells with patients from a rainbow of nationalities and cultures. No longer should we or can we expect patients to accept our arrogance or refusal to see them within their diversified and unique worlds, with their different values, beliefs, cultures, and lifestyles. As Saint Francis of Assisi reminded us centuries ago, we must “seek not so much to be understood as to understand.”