Medicine was once considered a place where patients could confide in their doctors about their most intimate concerns and doctors had time to listen. Notes were one- or two-line jots in a chart. We’d spend the extra time because we were valued for our skills and for our knowledge and there was more to it than just pay. We had skin in the game. We got paid in chickens. We knew our patients. Back then, seven-minute appointments didn’t exist.
Now, doctors are cultivated as shift workers. Patients have Google. Everyone has information at their fingertips. Our new story line has become there are no limits to what patients can have in health care. Perfect data. Perfect health care access. Error-free health care with perfect delivery. Perfect communicating doctors. Always. We’re building our medical Utopia.
But this effort to school doctors on our path to Nirvana has a serious downside for health care workers on the front lines.
As I’ve said before, there’s a growing culture of hostile dependency that continues to grow toward doctors these days. The theme is like an adolescent who realizes his parents have feet of clay. He comes out of his childhood bubble and realizes his parents have failures and limitations because they are human beings. This results in the adolescent feeling unsafe, unprotected and vulnerable. Since this is not a pleasant feeling, narcissistic rage is triggered toward the people he needs and depends on the most. None of this occurs at a conscious level. Most of us understand this behavior simply as “adolescent rebellion,” not understanding the powerful issues at play. So when we spotlight one side of what doctors should do for patients, be it improve communication or empathy (or whatever) without acknowledging the realities health care workers face like looming staffing shortages and pay cuts, we risk fanning the flames of narcissistic rage against the very caregivers whom we depend on the most - the very caregivers who are striving to communicate, do more with less, check boxes while still looking in the patient’s eyes, meet productivity ratios, all while working in a highly litigious environment.
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