The significance of the intimate personal relationship between physician and patient cannot be too strongly emphasized,” the great Boston physician and Harvard professor of medicine Francis Weld Peabody wrote in “The Care of the Patient” back in 1927. To Dr. Peabody, the clinical and the personal were deeply intertwined; a deep sense of intimacy between the physician and patient was essential to healing.
What would Peabody think of today’s Frankenstein healthcare system—pieced together inelegantly with no obvious logic. It is populated—no, overrun—with middlemen, actors and sub-actors who promise to fill perceived gaps in the healthcare system. Mostly of these middlemen insert themselves between the physician and the patient—in a space Dr. Peabody insisted should never exist. The doctor-patient relationship is inadequate, they tell us, refuting the remarkable simplicity of Dr. Peabody’s notion that the doctor-patient relationship, so long as it is maintained, is definitionally adequate.
Each day, people knock on our doors (and invade our email boxes and social media feeds) and tell us that there’s something that’s not happening in patient care that should be happening. They ask us to let them fix the problem. More often than not, they (and their investors—often venture capitalists and private equity executives) ask us to pay them to fix the problem.
If your patient isn’t taking her medication, we’re told, employees of a call center in some distant country will make them adherent for a low cost. We spend time building trust with our patients, but somehow, they hope to convince us, a set of well-intentioned, but ill-informed, and ill-equipped strangers is key to ensuring that the patient we know and recognize will put faith in our diagnoses and prescriptions.
Focusing intensely on specific conditions seems to be key to many of these companies’ business plans. There’s a startup that promises to help guide women through menopause, a job that the gynecologists I know are capable of performing. One company promises to use physicians and the latest technology to provide care in patients’ homes. Sounds good enough—until you realize the physician is a moonlighter or locums physican whose primary job description involves coding and documentation to increase the payments their insurance company receives from the federal government.