"I do not know a single thoughtful and well-informed person," George Bernard Shaw once said, "who does not feel that the tragedy of illness at present is that it delivers you helplessly into the hands of a profession which you deeply mistrust."
That sentiment is mild compared with some of today's reviews. Doctor bashing has become a blood sport. To judge by the popular press, which generally lacks Shaw's subtlety, too many physicians who are not magicians are charlatans. The ^ air of the operating room, where once the doctor was sovereign, is now so dense with the second guesses of insurers, regulators, lawyers, consultants and risk managers that the physician has little room to breathe, much less heal. Small wonder that the doctor-patient relationship, once something of a sacred covenant, has been infected by the climate in which it grows.
All this means that it is simply harder to be a doctor now than it was a generation ago: harder to master the art and the craft, harder to practice, harder to savor the natural pleasures of healing. Patients loudly long for the days of chummy family doctors and personalized care, when Marcus Welby would make everyone well. But it turns out that the distress is mutual, the frustration shared. Many patients may be surprised to learn that the doctors are suffering too. Listen to them tell it:
-- "Once most people treated me as a friend and a confidant," recalls Boyd McCracken Sr., 65, a family practitioner from Greenville, Ill. (pop. 5,000), who remembers making late-night house calls. "These days the malpractice threat has created a definite wedge between a physician and some of his patients."
-- "I think patients have become consumers," says Robert Rogers, an ophthalmologist in Pompano Beach, Fla. "They are no longer interested in their doctor, who has perhaps been their doctor for five, six, ten years. They are really interested in what it's going to cost them. It's just like they're going shopping at the local supermarket."
-- "I get no sense they trust me," says Jonathan Licht, a San Diego neurologist. "You tell them, 'You're O.K.' They say, 'No, I'm not O.K. I think I have a brain tumor.' Then they keep asking, 'How do you really know?' "
All across the U.S., among family doctors and brain surgeons, in large cities and small towns, the tensions are growing. Perhaps many doctors just miss their pedestals and the days when their patients were more respectful and their diagnoses unchallenged. But the soreness may also reflect the stresses and strains of a profession in transition. Nothing in medicine is stationary: the blinding speed of technological advances, the splintering effects of specialization, the onset of medical consumerism, the threat of malpractice suits have all bruised the doctor-patient relationship in recent years.
There are rich ironies here. Never have doctors been able to do so much for their patients, and rarely have patients seemed so ungrateful. Eighty years ago, a sick man who consulted his physician had roughly a fifty-fifty chance of benefiting from the encounter. The doctor's cheery manner and solicitous style were compensation for the uncertainty of a cure. "Medicine originally was mainly talk," says Sidney Wolfe, a physician who directs the Public Citizen Health Research Group in Washington, "and very little effective diagnosis and treatment."