By Jessica Schorr Saxe, M.D.
The Charlotte Observer, September 30, 2021
A few friends recently received letters informing them that their doctors were leaving their practices. The letters were perfunctory, acknowledging the doctor’s service and telling the patients that they could see other providers in the office.
In no case did the letters discuss the departing doctors’ plans — notably that they will still be practicing in Charlotte — nor tell the patients how they could continue care with their primary physicians.
I am both shocked and not surprised. This is one more example of the encroachment of business decisions on the practice of medicine, of the primacy of institutional profit over the doctor-patient relationship.
As a physician, I took the Hippocratic oath to work “only for the good of my patients keeping myself far from all intentional ill-doing” and to “safeguard the rights of my patients,” keeping their secrets and never revealing them. When I was in practice, I noted that the longer I knew patients, the more they trusted me, and the more they confided in me.
Patients told me their hopes, their fears, and their concerns about and dreams for their children, who were often also my patients. Sometimes, only after years, did they reveal histories of abuse that they had told no one. And, once I knew, I could help.
As far as I know, healthcare systems have not sworn to put your interests first, nor been educated to respond to your innermost fears. Their decisions, as well as those of insurance companies and drug and device companies, often prioritize market share over patient care.
Trust is a fundamental, if underrated, ingredient in the success of medical care. We have seen this only too painfully in vaccine resistance during the pandemic. Trusted primary care physicians can play a crucial role in vaccine acceptance. And during this pandemic, patients need trusted physicians to help them with illness, fear and loss.
When doctors are treated as interchangeable parts in someone else’s machine, we are not in positions to establish that trust. Patients suffer, and doctors suffer as forces distance us from the sanctity of the relationships with patients that called many of us into medicine.
None of us should give in to this.
Patients: Be vigilant and watch out for financial decisions taking precedence over your care. If your healthcare system claims to be patient-centered yet is willing to sever the doctor-patient relationship, let them know that violates your trust.
Fellow physicians: Don’t stand for it. We took oaths, we belong to a venerable profession, we walk— or should be walking — in the footsteps of giants: Hippocrates, Rebecca Crumpler, Sir William Osler, Arnold Relman, to name a few.
Medical practices: Have respect for the doctor-patient relationship and let patients know if their doctor can be seen elsewhere. Forego a short-term business advantage for the long-term welfare of patients.
Medicine has changed. Our forebears would be fascinated with the worlds opened by MRIs and genetic testing. I would hope they would recognize the benefits of the gender and ethnic diversity they would see in the faces on hospital rounds. But they would undoubtedly be appalled by the idea of the business of medicine. In fact, Osler, the father of modern medicine, said so explicitly:” The practice of medicine is an art, not a trade; a calling, not a business.”
Nearly 30 years ago, I wrote in the Charlotte Observer about “Musical Doctors,” when, as though they were children playing musical chairs, patients were abruptly forced to change doctors because of changes in insurance. I decried the interference in the doctor-patient relationship. I quoted Hippocrates, who said “. . .some patients, though conscious that their condition is perilous, recover their health simply through their contentment with the goodness of the physician.”
Instead of nurturing the relationship between doctors and patients, we have moved in the opposite direction. If we want to recapture the benefits to all of us, we need to let our institutions know how important those relationships are to us.
Dr. Jessica Schorr Saxe is a retired family physician in Charlotte. She is chair of Health Care Justice North Carolina.