A co-worker of mine is going through some medical tests, and she is complaining. She says that doctors order too many tests, and that it is killing her to pay for all of them because she hasn’t hit the deductable on her health insurance yet. I point out that they only order so many tests because if they miss something, they open themselves up to malpractice lawsuits, and then their premiums go up. Doctors order extra tests for the same reason we look both ways before we pull out into an intersection while driving: they do not want to pay more for insurance.
There was an article in the Washington Post a couple of days ago talking about alternative medicine, written by a Dr. Manoj Jain. He states that a number of his co-workers who get both conventional and alternative medical care complain that doctors are too brief with patients. One of his nurses told him:
Judy summarized her experiences without mincing words. A conventional doctor “listens to my symptoms and is quick to prescribe a medicine or to order tests. My instructor listens to my story and works with me.” I asked her for another example.
“Well, do you remember two weeks ago, when I had a terrible cold, followed by a cough, low-grade fever and lots of sinus drainage, and I came to your cubicle? In less than a minute — listening to my symptoms — you said, ‘You have sinusitis’ and called in antibiotics.” The drugs worked, but she thought the encounter was a little too quick. “I am not criticizing you, but that is how conventional doctors work.”
Myself, I prefer doctors to give quick answers. But Dr. Jain points out that the placebo effects are powerful things, and that they can make the difference in quality of care.
Dr. Jain does not come off as being soft on alternative medicine, although he may be a bit of what the bloggers over at Science-Based Medicine call a “shruggie.” He seems to attribute the power of alternative medicine to the interest that practitioners take in their patients, compared to then”15-minute office visits, recurrent insurance denials and unnecessary diagnostic tests to avert malpractice suits” that patients see in conventional medical care.
Jain is not really talking about medical practice. He’s talking about the pitch (ironically, he refers to alternative medicine as “snake oil” in the title. Snake-oil is all about the pitch). He refers to alternative practitioners as “good used car salesmen…with little scientific proof,” but he doesn’t see that as a bad thing, and thinks that some of the pitch of alternative medicine can help doctors relate better with their patients, and help the patients trust conventional treatment more than they currently do.
In psychotherapy, we occasionally see news stories that point out that what we call the therapeutic alliance, the bond that forms between a therapist and his client, is a better indicator of successful therapy than the use of any particular technique. This is old news that gets rehashed as “news” every time a new study is released. The client wants a therapist who will take time to listen to his client, male recommendations, and work with the client. It shouldn’t be stress-free because there is no change without stress, but it shouldn’t be contentious.
Doctors may be able to take some lesson from this. Perhaps If doctors could spend more time with each patient, talk to them more, and make the same recommendation they would have made in five minutes under the current system, patients would feel better about their care.
Of course, the question is how do you fit that into the current system?