The importance of the doctor-patient relationship, continued
Many physicians find themselves envious of the unbending resolve with which lawyers are able to embrace their most basic role of advocacy. Lawyers retain this luxury because society recognizes the legal system to be a morass of rules and regulations which ordinary citizens cannot hope to navigate on their own. Any citizen who becomes embroiled in this morass is universally acknowledged to have the right to a lawyer who is expected to hold that citizen’s interests above all others (within, of course, the constraints of the law). Even those accused of the most heinous of crimes are entitled to legal representation, and even if the evidence against them seems overwhelming, their lawyers are expected to jealously guard their rights. While the rest of us may become frustrated and angry when we observe the rights that accrue to (in our eyes) an obviously guilty party, on an objective level most of us understand the wisdom of such a system. And we shudder to think of the abuses that would occur if these protections were removed.Doctors are expected to fill for their patients the very same advocacy role that lawyers fill for their clients. This role is necessary, because sick people are no more capable of navigating the complex health care system than are accused felons the complex legal system, and are no less in peril if they run afoul of that system. And a patient’s need of an advocate, a professional whose job it is to protect the patient’s own best interests, is no less vital than that of the felon.
Over the ages the doctor-patient relationship has been defined, through rules of ethics and rules of law, as a fiduciary one, as a relationship founded in trust. When a patient seeks a physician’s help and the physician agrees to give that help, a special covenant is made. The patient agrees to take the physician into her confidence, to reveal to him even the most secret and intimate information related to her health. The physician, in turn, agrees to honor that trust, and to become the patient’s advocate in all matters related to her health, placing her interests above all others – including his own personal or financial concerns.
Now, to be sure, the doctor-patient relationship was never completely pure in actual practice, even in “the good old days.” But a strong fiduciary relationship has been what patients have expected, what most doctors have striven for, and what everyone else (the medical ethicists, professional societies, and those who write and enforce the laws of the land) have traditionally agreed – and even demanded – should be the standard. It represents the fundamental expectation of how doctors and patients are supposed to behave toward one another. The benefit of such a relationship to patients is obvious; the benefit to doctors is just as important. It is their duty as advocates that imparts any and all claims physicians may have to the title “professional,” and to the perquisites and considerations that flow from that title. Without this role, physicians are no longer professionals. They truly are reduced to mere commodities in a vast healthcare marketplace.
While the traditional doctor-patient relationship is vitally important to both patients and doctors, it is nonetheless true that - because society has decided that covert rationing must go on - we can't have it anymore. And it is the imperative to ration health care covertly, and as a consequence to destroy the doctor-patient relationship, that explains all the seemingly bizarre behavior we see taking place every day in the American health care system.
What does the loss of the doctor-patient relationship mean to patients?
It means that when you are sick, you cannot expect the same kinds of rights and protection we give without question to, say, accused felons.While you may be lucky enough to find a doctor who is adept at "gaming" the system, or who will take personal risks to get you what you need, you certainly can't count on that. Especially when you are dealing with a potentially life threatening disorder - like heart disease - you can no longer assume that whatever needs to be done will be done. You can't be passive. You've got to take responsibility for and control over your own health care.
