A lot has been said lately about the need for
doctors to appear more patient, compassionate,
and concerned. Several studies attribute a physician's
higher risk of being sued for malpractice to a
lack of such attributes rather than to any failure
in providing quality medical care.
Health insurers, health maintenance organizations,
and patient advocacy groups have also done extensive
surveys on patient satisfaction and concur with
the need to encourage doctors to be "more
To promote "the art of caring" a teaching
scenario could be developed for physicians. Of
course, both a patient advocate and an insurance
company advocate should oversee the physician’s
lesson which might proceed as follows.
The test begins with a patient presenting to
an emergency room complaining of abdominal pain.
"How long have you had these pains?"
the doctor asks.
"About three months," the patient
"Three months," the insurer muses.
"This is obviously not an emergent problem.
They should be worked up as an outpatient. Well,
go on. But retrospective review is just not gonna
authorize this visit."
"And have you seen anyone else about these
The doctor continues.
"Oh, yeah," the patient replies, then
adds. "Well, he was my wife's doctor. She's
an interior decorator. She did his house in Southwestern
The doctor cuts him off to get back to the medical
"No, no, no!" the patient advocate
admonishes. "Patients sometimes deliver a
history in a more obtuse manner than a physician
prefers. You'll better serve your patients if
you're - more "patient."
"But remember," The insurer adds,
"you have forty people to see today. And
patients don't like long waits."
Continuing the exam, the diagnosis seems obvious.
And the doctor scribbles a prescription.
"You're not going to run any tests?"
the patient advocate says beratingly. "How
do you know he doesn't have cancer? You ought
to do a CAT Scan or an MRI."
"No," the insurer says, "If it
doesn't get any better in another month, we can
consider other testing then. You just can't shotgun
expensive tests for every patient. That's why
medical costs are skyrocketing."
Then, the phone rings. "It's Dr. HuYuTink,"
his nurse announces.
"Don't answer the phone," the patient
advocate says. "Try to avoid interrupting
patient care. It demonstrates a lack of concern
"Answer the phone," the insurer advocate
demands. "It's probably the HMO gatekeeper.
He'll want you to transfer the patient to their
primary hospital cross-town."
"It's my doctor," the doctor explains
and answers the phone. "Hello, Dr. HuYuTink?"
"I'm sorry," the doctor's doctor says,
"I have to cancel our session for today."
"But my nerves are getting worse."
"Just continue taking your tranquilizers.
If you start to hyperventilate, rebreath in a
paper bag. I'll see you next week. Goodbye."
The doctor turns to the patient advocate and
the insurer and shakes his head in dismay. "My
doctor," he says, “he just doesn't care."