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For more and more doctors, that is just too much to ask. They feel the wrath of their patients and realize the job is not going to get any easier. A March 1986 survey of physicians in the Minneapolis-St. Paul area found that nearly two-thirds of them were "pessimistic about their professional futures," and a like number said they would not want their children to go into medicine. Applications to medical schools for the 1988-89 school year declined 15% from 1986-87, reflecting a contagious concern about the profession's future.
As ambivalence and hostility divide doctors and patients, medical experts are struggling to explain the troubled relationship and find ways to revive it. Some of the conflict arises from human nature. How can doctors feel comfortable when patients come into the office prepared to sue them for everything they own? How can patients trust a doctor who has a clear financial interest in prescribing expensive, intrusive and perhaps unnecessary therapies? When doctors disagree, how can a patient know whom to believe? Both sides recognize that the demands of treatment have changed in ways guaranteed to alienate doctor and patient.
The most obvious source of friction is the new technologies that enter into every stage of treatment. Since the end of World War II, as the science of medicine rapidly evolved, the craft overtook the art. Many physicians regret that they now spend far more time testing than talking, which may make for more accurate treatment but less personal care. The race to stay abreast of each new development can consume a doctor's every waking moment. "Technologies have put a kind of emotional moat between doctor and patient," laments David Rogers, professor of medicine at Cornell University Medical College. Some tests, particularly the CAT scan and colonoscopy, not only frighten but dehumanize patients by reducing the body to an intricate piece of machinery.
Doctors often find they can do more but explain less, leaving their patients with the impression that treatment is not to be understood, rather to be suffered. The doctor, for his part, may want to reassure the patient, but balks at taking the time to deliver a discourse on molecular biology. "You have to be tolerant," says Lake Forest, Ill., cardiologist Jay Alexander. "You have to be able to answer questions, and it's got to be an answer that the patient is able to understand. Twenty years ago, I imagine, less explanation would have been necessary." The suspense and confusion weigh heavily on patients and their families. Author Norman Cousins and his followers believe lack of concern for the patient's state of mind can actually cause physical harm. "At its worst," argues Cousins, "it's a form of malpractice."
Yet keeping patients informed becomes ever harder when each test is performed by a different technician in a different building, with no one wanting ultimate responsibility. For Josefina Ponce, a day-care worker in Los Angeles, it took four visits and twelve doctors to have one gallbladder operation. "I saw one doctor in the emergency room, then a second doctor," she recalls. "On my second visit, I saw three different doctors who knew nothing about my case. I was told what my surgery date would be, and I said I wanted to meet my doctor. But I was told there would be five doctors, and it could be any one of them."