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Other patients are shopping not for savings but for status. This inspires physicians to spend valuable time on self-promotion and merchandising, not skills that contribute materially to patient care. "My feeling was that if you're a decent physician giving decent service, that's really all you should have to do," says Florida ophthalmologist Robert Rogers, who has hired a business consultant to help manage his practice. "But patients don't seem to want that. They like the flashy stuff. They like to see your name in print. They like to see you lecturing."
In an effort to be educated consumers, today's patients read books with titles like What Your Doctor Didn't Learn in Medical School and Take This Book to the Hospital with You. The message is that a smart patient is an informed patient, who challenges a doctor's authority rather than submits uncritically to the physician's will and whims. Yet that approach rubs raw against a basic instinct. Patients want to trust their doctors, to view them as benign and authoritative. Even those who privately question a doctor's decisions may be loath to express dissent. Doctors admit that an aggressive or challenging patient can be very irritating. "When you can, under certain circumstances, play God, you sometimes tend to behave like you are God," says Cornell's David Rogers. "The enormous satisfaction of being able to help a lot of people makes you impatient with those who question your judgment."
The ultimate price of inflated expectations and consumerist attitudes is the treacherous legal reality that confronts doctors today. Anything short of perfection becomes grounds for penalty. And once again, while it is the doctor who must pay the high insurance premiums and fend off the suits in court, the patient eventually pays a price. The annual number of malpractice suits filed has doubled in the past decade and ushered in the era of defensive medicine and risk managers. No single factor has done more to distance physicians from | patients than the possibility that a patient may one day put a doctor on the witness stand.
Manhattan cardiologist Arthur Weisenseel remembers the elderly woman who arrived in Mount Sinai Hospital's emergency room having suffered a heart attack and battling pneumonia. A man and a woman hovered by her bedside, and the emergency staff assumed they were worried relatives. Then the man pulled out a yellow pad, asked for the correct spelling of Weisenseel's last name and identified himself as the family lawyer. "I kind of lost it that day, and I told him to get out," Weisenseel recalls. "That may have been the most distressing situation I've had in 22 years of practice."
The impact of possible litigation is felt long before a patient sets foot in the doctor's office. Some physicians, like Linda Bolton, a pediatrician in Birmingham, Mich., try to screen out potential problems. "It really dictates what happens at the office. If I feel I have people who are litigious, I prefer not to take them as patients." In the past, she has fixed her rates only after she has been notified how much she will have to pay for malpractice insurance.