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Compare that with the prospects of today's patient: what was once miraculous is now mundane. The flutist has her severed hand sewn back on. The man with the transplanted heart goes skiing. As a society, Americans are living longer and well and with less to fear from diseases that ravaged whole generations. Life expectancy has jumped during this century from 47 to 75 years. And yet the physicians, victims of their own success, are finding that however swift the advance of medical knowledge, it is still outpaced by public expectations. "The public thinks that all diseases should be treatable, all disabilities reparable," observes John Stoeckle, chief of the medical clinics at Massachusetts General Hospital. "And there should be no pain and suffering."
So naturally, the public is far from content. In part the problem lies with the failure of the profession and the government to police medicine adequately, since the stakes could not be higher. If a stockbroker is incompetent, his client may lose his savings; if a doctor is negligent, his patient may lose his vision, his memory, his mobility or his life. Though the public, the government and the physicians themselves have become more vigilant, the persistent stories of medical mishaps continue to take their toll on patient confidence.
The anger and suspicion toward doctors are easy to measure, even without reading the tabloids or watching Geraldo for the latest tally of medical misdeeds. When the American Medical Association conducts surveys of public attitudes toward physicians, it finds a troubling loss of faith. Even people who esteem their own physicians often deride the profession as a whole. In 1987, 37% of those polled did not believe doctors take a genuine interest in their patients. Only 45% believed doctors "usually explain things well to their patients."
A doctor's words may speak louder than actions, but every patient hears them differently, and doctors end up feeling they cannot win. When Cincinnati receptionist Doris Roetting had a mastectomy in the fall of 1987, her surgeon assured her that she was recuperating nicely. Her oncologist, however, was a bit more explicit, to Roetting's dismay. He quietly explained that she had a 90% chance of being alive in five years and an 80% chance of surviving ten years. Some patients might have been grateful for such candor; Roetting went home in tears. "I think everybody who has cancer knows there is a chance they can have it again," she says. "These doctors should show a little more finesse."
Tact and tenderness may be a lot to expect from someone who must spend roughly twelve years learning the trade, work impossible hours, be available to patients day and night, keep abreast of changing technology and live a peaceable life while constantly dealing with death. "The patient wants the best of both worlds," charges Lester King, a Chicago physician and medical historian. "He wants the knowledge and precision of the most advanced science, and the care and concern of the old-fashioned practitioner."