I noticed that several medical schools have opted to add humanities to the medical school curriculum recently. They feel that it will improve the physician’s ability to communicate and relate to his or her patients. Although it was too many years ago, I seem to remember the medical school curriculum didn’t need many extras to become too full. When I first saw this addition of humanities, I wondered what had brought these institutions to this decision. I suspect that several of these teachers had heard from a relative or a friend about how the physician they had seen did not attempt to do more than perform an abbreviated examination and treatment. Not too many years ago the physician had time and could converse with the patient in a not quite so perfunctory manner. The relationship of the physician and his patient was more personal and less mechanical.
I believe the intent of the medical school to introduce humanities to improve the physician patient relationship is well intentioned but is totally misdirected. To allow the patient to relate more closely to his patient the courses that need to be added are not the humanities but rather financial and office management.
The wedge that has developed between the patient and his physician has been caused, to a great extent, by financial considerations. There was a time when the physician’s goal was to have a satisfied patient, the patient being the one paying the bill and hopefully helping in referring more patients to the doctor’s office. Today the entity employing the physician is concerned with getting more subscribers, cutting costs and generating income.
Today the need to satisfy is diverted to the physician’s employer or insurance company who are responsible his or her income. Time is a major factor as is the need to generate a lengthy medical report to justify the charges. A visit characterized by assisting the patient with personal problems does not do much for the insurance company and results in time that detracts from the physician’s “productivity” which is what he gets paid for. Several of the physicians I know, who spent too much time with their patients, had their pay cut and have either learned what is required or found other employment.
The physician must realize that he or she is a production tool. Letting nurses or physician assistants do all of the mechanical portions of a medical visit should allow the physician to cut the time he or she needs for their part of the visit. More patients seen, means more generated income. Computers capable of generating the normal written parts of the examination permit the physician to contribute “significant” findings quite rapidly.
If the medical schools want to improve the patient- physician relationship it would be best to increase the physician’s understanding of economics and how this will have an impact on his or her ability to practice his or her craft.
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