An Unsettling Question

A few days ago, I received a question that stopped me in my tracks. I was giving a talk to a local church group on the importance of patient advocacy, and most everyone was nodding. Yes, doctors don't always listen--let's do something about it! Yes, we need to control of our health!

Then someone raised her name. Her name is Susan, and she is the owner of a mom-and-pop grocery in South Boston. "I don't understand why the responsibility is always on the patient," she said. "What about doctors--why don't they have to change anything? Patients are the ones who are sick, who are coming to a professional for help. Yet everything that's coming about is about how patients should read more and do more research. Now you're telling us that patients have to stand up to their doctors--well, shouldn't it be the doctors who need to aim to do better instead?"

This question gave me a lot of pause because Susan is right. It is the doctor's duty to do right by the patient, and that means, if there is a problem, that doctors should be the ones to improve their practice. Many doctors are extremely caring and provide excellent care to their patients. Unfortunately, there are some who, for whatever reason, do not.

In the ideal world, such doctors would choose to educate themselves and voluntarily work to improve their practice; or else, patients would choose to go elsewhere. Neither of these is not entirely realistic. First, we know that doctors are slow to change. Second, patients don't always have a choice of doctors. You may encounter a doctor in the E.R. who you don't choose, or your insurance may prohibit you from going to other specialists. If this is the case, you can't exactly wait until your doctor chooses to improve. So why not make your healthcare experience as good as it can be?

Ultimately, improving medical care needs to involve the doctor too. To that end, education must begin early. As past president of the American Medical Student Association and now as a senior resident, I have met thousands of medical students, and can attest that virtually all medical students enter training with the right mindset. They want to help people; they want to listen; they want to care; they want to do the right thing. Something about the medical training dissuades them from these noble intentions, and when medical students become cynical residents and then hardened attendings, it is often too late to change them back. Medical education reform is critical to ensure that we are producing doctors who are empathic and socially accountable to our patients and communities.

Medical education reform takes a long time to happen. Health systems change takes a long time too. These need to happen--but it's going to take a while, and your health can't wait until then. This is what I explained to Susan. While we work on education and reform of doctors, patients can make the most out of our healthcare experiences and ensure that we and our loved ones get the best care possible for us. The message of our book is tailored to patients not because we are putting all the pressure on them, but rather because we believe each person can make a difference in their healthcare today--starting with their next encounter with their doctor.