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The combination of these factors -- the welter of technology, the intrusions of corporate medicine, the high expectations of patients and the threat of malpractice -- has cast a pall on the practice of many older physicians. "I detect a certain despondency among doctors my age, in their later 50s," says Memphis surgeon Galyon. "They will frequently say something to the effect, 'I'm glad I'm this far in my profession and not starting out.' "
Oddly enough, many young physicians do not feel the same way and still see in medicine a career of compassion and challenge, despite its loss of luster in recent years. Their attitudes may reflect new priorities in many medical schools. Traditionally, med school, internship and residency were a notorious, competitive ordeal that all but guaranteed less humane doctors. "It makes book learning and grade getting their yardstick, not kindness, gentleness and taking care of people," says Dr. E. Grey Dimond, founder of the School of Medicine at the University of Missouri at Kansas City and a leader in humanistic medicine.
That may be changing, thanks to some innovative programs that are challenging the conventional curriculum. The most visible experiment, following an example pioneered at Missouri, was launched at Harvard Medical School in 1985. The goal of Harvard's New Pathway Program was to focus from the very first day on the doctor-patient relationship, rather than rely solely on textbook learning. "Even in an era that is overlaid by science and technology," says Harvard Professor Ronald Arky, "doctoring still involves an intimate, close contact with the patient, and somehow that was being pushed out." Small groups of students work closely with a physician and meet with patients on hospital wards almost immediately, in an effort to mix basic science with clinical decision making. Course work draws not only on science but also on literature, history, anthropology and sociology.
As more hospitals and universities increase the emphasis on the doctor- patient relationship, there are signs that attitudes are changing. When humanistic courses were introduced in the 1970s, high-powered students resisted what they viewed as soft science. "Now the students see that the shine on their shingle is affected by what people think of them as human beings," says author Cousins. The profession is attracting a different kind of student: many are less concerned with accumulating wealth for its own sake and more comfortable with patients who ask questions and challenge authority. "It's a much more difficult field now," says Dr. Matthew Conolly at UCLA. "I think we'll see a different set of motivations."
Doctors and patients alike may look forward to the day when better relations mean better care. A strong bond makes it easier for doctors to craft their therapy to the patients' needs. More cynically, some experts predict that competition among doctors will force a more humane approach as a selling point. Finally, the problem of reimbursement could be relieved if insurers came to value a good doctor-patient relationship and were willing to allow doctors more discretion. Says consumer advocate Rooney: "It's a recognition that, in the long run, it may be more important to talk to someone at age 28 than it is to clean out their arteries at 78."