Q: What Scares Doctors? A: Being the Patient

What insiders know about our health-care system that the rest of us need to learn

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It's hard to find a doctor who doesn't worry about how medicine is changing, since they suffer at both ends: as providers of health care and as consumers. "What scares me most about the current medical environment is complacency with the status quo," says Martin Palmeri, an internal medicine resident at Dartmouth-Hitchcock Medical Center in New Hampshire. Burgeoning bureaucracies, managed care, the mass production of health-care services and a worsening malpractice climate only strain the doctor-patient relationship. In this environment, the patient, typically a physician's source of inspiration, can become the source of frustration. "When I refer one of my family members to someone," Palmeri says, "I want to make sure that they are the type of physician who leaves no stone unturned and will burn the midnight oil if need be to ensure the highest-quality care possible."

What frightens doctors--young ones like Palmeri as well as older ones--is that those doctors may be harder and harder to find. Scientific knowledge improves, but the care doesn't keep up; it is easier to gather gigabytes of information than to acquire the judgment to apply it wisely. It might comfort the rest of us to think that with just a little more knowledge or a personal doctor at our side, we could get the best out of America's extraordinary health-care system without suffering from its gaps and failures. But since even an insider can suffer, we are left with the much harder challenge: to fix the system for everyone.

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