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Under Assault

by David Stevens, MD, MA (Ethics)

The doctor-patient relationship, the stronghold of medicine and dentistry, is under assault. Malpractice is raining the flaming pitch of distrust over the walls where it is damaging lines of communication and lighting fires of suspicion in the examining room and at the bedside. Those burned by the inferno find their professional confidence in meltdown, their psyches scarred and their very livelihood increasingly threatened.

As if this aerial bombardment wasn’t damaging enough, the battering ram of limited time is bashing the gates. With only five to seven minutes per patient, can a meaningful relationship be formed and sustained? That log is hitting harder from the impetus of lower reimbursements, combined with the hard nose reality of increasing bureaucracy and paperwork. Doctors are spending less time doctoring and much more time being clerks. The portals are splintering from the unrelenting forces of the bottom line.

Sappers tunneling under the walls are the greatest danger. The foundation of medicine is the covenant relationship between doctors and those they care for. In this covenant, doctors are responsible to a higher authority that holds them accountable. God is looking over the physician or dentist’s shoulder analyzing their competency and their ethics, but He is not the only one who arbitrates the covenant relationship. The doctor’s colleagues judge whether they are using their knowledge as they should – always for good and never for harm. The covenant doctor realizes that he has a fiduciary relationship with his patients, who have entrusted their lives and well being to him.

Yet this foundation is being blasted by the volatile belief that the real governing force in medicine is simply what the patient wants. This thinking makes patient autonomy the trump card over any other consideration and ultimately relegates the doctor to being a technician ready to follow the patient’s every whim. In this way of thinking, if the patient thinks his life is no longer worth living, then the doctor has the duty to help him commit suicide. What right does a physician have to deny someone the right to recreate himself through cloning, as long as it brings that person fulfillment? In a contractual world, medicine is a commodity and physicians and dentists are merely body mechanics. This type of thinking is digging a honeycomb of tunnels under the walls of medicine. Unless something is done, the walls will ultimately collapse.

How can doctors resist the onslaught?

We can no longer bunker down hoping things will turn out all right. If we just shore up the walls and barricade the gates, we only delay the inevitable. The best defense is to go on the offense. We are already seeing progress with the malpractice issue as doctors stand together to say, "We won’t take this any longer." As we raise our voices for our patients’ sake we can change a system that at the end of the day, harms them. We must also fight for patient-doctor continuity and enough time to do our job well. Our patients need it and so do we. Both the patient and the doctor find their greatest satisfaction in their relationship.

How to protect our profession from moral and ethical erosion will occupy this column in coming issues.

There is strength in unity. Though embattled, working together we can protect the doctor-patient relationship and our profession from destruction. The alternative is too tragic to contemplate.