Front Porch: Searching for what ails medical profession

Two weeks ago I asked a question here: Where have all my doctors gone? And I talked about feeling abandoned at the growing loss of the medical care providers – doctors largely in their 50s – in whom I have placed trust. Today, it’s about them.

As with everything complicated, there aren’t sound-bite solutions to the growing migration away from their medical practices by physicians midcareer. There are a lot of surveys and information discussing this exodus, largely focusing on depersonalization and corporatization of medicine, but whatever the myriad reasons, this particular statistic concerned me: A report last year from the Association of American Medical Colleges projects a shortage of from 42,600 to 121,300 physicians by 2030 – and this in a nation that prides itself on being and having the best and the most of just about everything.

Except, apparently, enough doctors and a medical system that attracts them and allows it to be such that they want to stick around. I’m not advocating for any particular fix – that’s way above my pay grade. I’m just trying to understand why the men and women who normally go into medicine are opting for other fields or getting out of clinical practice once in the field and turning instead to teaching, research, hospital leadership, work in the medical insurance area, lobbying or the pharmaceutical industry. Or just retiring early.

I want to know this because it’s affecting me personally. I’m in my 70s. I don’t know how many new doctors I can personally break in any more.

I know that as a society, we’re not too inclined to put a lot of sympathy into the plight of our doctors. After all, they make buckets of money, right, so what’s to complain about? Would that it were so easy. I do know that there are many nondoctor things they are now required to do for the same money and in the same amount of time. Despite all I’ve read, the most clarity I got was in a conversation with a family friend, a doctor in her 50s in the Seattle area.

While people enter the field for a variety of reasons, she said, most want to take care of people. Independent providers cannot afford or manage all the required insurance and legal issues that a conglomerate can, so the kinds of stand-alone practices many of us grew up with cannot survive today. Big health systems have to monitor the physician’s time so a profit can be made. Doctors cannot spend the time with patients they would like to. Frustration and overload set in. Physician suicide rates are high. Burnout is real. Many are walking away for other work, often in a related area, that is still financially rewarding, but also (hopefully) soul-satisfying. Like teaching.

That’s kind of a nutshell description of a longer conversation, but what she told me that physicians miss – and what often drives them away – is the lack of time to hear the patient’s story.

“With the advent of electronic medical records, which we have for good reasons, we find ourselves typing as we talk to patients. There’s no eye contact. Patients don’t feel a connection to us as they did before,” she said. “And we don’t do as good a job of finding out what’s really going on. When we ask about a symptom, there are algorithms at work helping us with the diagnosis, but what we can miss is the psychological overlay in the disorder, things that can worsen the symptoms.

“Quite simply, we need to hear their story, the narrative. There isn’t a box to check for that.

“From the provider’s standpoint, we just need to get on the raft and head downstream.”

She concluded with a famous adage: The patient will tell you what’s wrong if only you listen long and carefully enough. The diagnosis is the story, she said, as is the treatment. “Even telling the story is therapeutic for the patient, according to an every-growing body of cognitive and neuroscience data. Because relationships heal.”

There is no longer time for the relationship. Many doctors find themselves deeply dissatisfied, unhappy or depressed – and wind up having to leave for the sake of their own well-being. Sure, there are other reasons and motives, but my friend tells me this one is the big one.

Neither she nor I will be able to fix the health care system or keep physicians from leaving their practices, of course. Too big for us. But let’s start with something small and local. What can we patients do to get the best health care the way things are today? My friend offered three tips.

First, take someone with you when you go to the doctor’s office. Another set of eyes and ears. If you need a trained patient advocate, some of the bigger hospitals have them on staff. Outcomes often improve if you have someone with you as your advocate.

Second, do research, if you can. Online is fine, but be sure to go to responsible sources, so that you can target good questions from good research and so that you have some knowledge ahead of time if you know what problems you are dealing with.

Third, there are low-cost ongoing resources available. Health and nutrition newsletters from Tufts, Harvard, Mayo Clinic and others. Some have a small fee. Many of these deal with general health concerns, others focus more specifically – women’s health, cancer, diabetes, etc. Be informed and stay informed about your particular issues.

When we talked about these things, my friend was intrigued with the idea that a patient wanted to advocate for her doctors.

“We have been caught in the middle of this health care crisis, too,” she said. “We are frankly a little bit stunned. We want to take care of people.”

She said that if patients pressed for more time with their doctors, wrote to their Congressional representatives and “perhaps even marched on Olympia – it would bring tears to many doctors’ eyes.”

What a concept. Of course, doctors are people, too, and they need our care and concern, just as we need theirs. That’s not such an outrageous thought.

I want my doctors back, but more importantly, I don’t want them to leave in the first place.