(COPYRIGHT STEMMLER, 2004)
For today's urban patient, the doctor as a patient advocate seems to be a thing of the past. Something one reads about in a turn-of-the-century novel, or that family doctor story our grandmother used to tell us, over and over, as we sat, incredulous, around her. Or perhaps we think of such a doctor, when listening to one of Leonard Cohen's old rock songs, "Everybody knows." In the line; "…everybody got this broken feeling, like their fathers or their doctors died…", Cohen compares the relationship between patient and doctor to that of a father and his very own child. Cohen's poetry is about a person many of us wish for in a doctor, but most of us have yet to meet. In today's medical environment few doctors would qualify as advocates for their patients. Certainly not the rushed specialist who cannot see the patient for the procedure and its underlying cash value. Not the overworked, exhausted primary care doctor, who has a waiting room full of patients, drawn from a dozen managed care company "lists". Not the self-centered egotistical expert, who walks on water as he enters the room of the patient, followed by an entourage of multilevel students, immediately invalidating the patient by speaking loudly, and in medical jargon, not with the patient, but about the patient to the crowd behind him. Today's patients are impressed by the big medical centers, their rich decor and elegance. But when they arrive there as a patient, they are often treated poorly and not elegantly at all. They often endure endless rolls of red tape, inconsiderate waiting times, rude receptionists, uncaring nursing staff and, finally, the doctor. The doctor might be just as rude, more than often rushed and, even if nice enough, rarely kind and compassionate - why? Because those large institutions, many of which toot their own horn as the best and the biggest, simply do not have a humanistic philosophy, one that puts the patient on the highest level of the organizational scale. They operate on a business model, a model that entices patients to come, but once there, it is the patient's insurance or their purchasing capacity, that becomes their main source of interest. When a person is sick, they need a doctor, not a businessman with an M.D. degree. They need a person that is kind and compassionate, and one that will stand behind them as long as they are needed. We have a shortage of physicians who are qualified to serve as patient advocates. Perhaps it is time to develop a new specialty with an old concept; that of a man or a woman with a combined medical and humanistic education. Somebody who can advise the patient and guide them through the often scary maze of contemporary health care. A physician who understands human nature and values the individual life philosophy of each person. One who is knowledgeable in the multiple options available locally, nationally and internationally for the effective treatment of illness. Somebody who listens, educates guides, encourages and always, always puts the patient's interests and wishes first.
Christina Stemmler, M.D.
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