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Thu Sep 11 17:12:43 BST 2008

Healing the Doctor-Patient Divide
By PAULINE W. CHEN

"I don't rely on the doctor anymore. These days, you have to look out for
yourself."

Those words, and the smell of grilled meats, wafted by me at a recent
potluck dinner party.

My husband and I had tagged along for a summer reunion, where my
sister-in-law and her husband joined a group of 40-, 50- and 60-somethings
who were visiting their hometown, eager to catch up on their childhood
buddies' lives.

The chatter started as one would expect -- five-minute recaps of work,
children, parents and summer plans. But as the evening progressed, the
gossamer conversations of this boomer crowd seemed to spin into one thread:
the state of one's health. Or our parents' health. Or our children's health.

And no matter the specifics of each story, they all seemed to revolve around
one theme: that as a patient or the family of a patient, you would feel at
odds with the very people who were supposed to care: the doctors.

Looking back on that night, I realize that the conversations in this polite
crowd might have taken a different bent if the guests had known that one
among them happened to be a surgeon. I also realize that because I am a
doctor it might have only seemed like everyone was talking about health.

But I don't believe that the stories I heard that night are the exception.
In fact, I think they may be the norm.

More and more Americans feel disconnected from their doctors, especially
compared to a generation ago. And they certainly have less confidence in the
profession as a whole. In 1966, a Harris Poll found that almost
three-quarters of Americans had "a great deal" of confidence in their health
care leaders. That number has steadily dropped over the last four decades,
so that today only slightly more than a third feel the same way, the same
poll shows.

I can't blame people for losing their confidence in medicine. My
mother-in-law has been in and out of hospitals for the past couple of years.
While a few of her doctors have been extraordinary, there have also been
enough mishaps and misinformation to make me cringe every time the threat of
another hospitalization looms.

Moreover, when her kids ask her which of her doctors is in charge, my
mother-in-law can rarely provide a name. At first my husband speculated that
his mother was suffering from memory loss. But he and his sister have since
learned that in-house doctors turn over so frequently that even the most
intact intellect can lose track.

I know there's a problem with the way medicine works these days, but as a
surgeon, I've also stood on the other side. I have felt my heart drop when a
patient whose new liver I struggled to sew into place decides without
telling me to stop taking immunosuppressive medications. I have felt a pang
in my chest when, still paying back student loans 15 years after my last
graduation ceremony, I can hear a patient questioning not my therapeutic
recommendation but my financial motivation.

And I feel a great sadness for my profession and my patients when I hear
conversations like the ones I heard at that summer potluck.

When I started medical school 22 years ago, I believed that I could have the
kind of relationship with patients that I had had growing up with my
pediatrician. "Dr. Kirkland" unflinchingly jabbed immunization needles into
my arms, regularly tapped my hyper-reflexive knees with a rubber hammer and
pulled no punches when I, the moody adolescent, sulked in his waiting room
or stormed out of his office.

But despite those difficult moments, I knew that ultimately we stood
together. These days I'm not sure many of us -- patient or doctor -- can say
the same.

There is a tragic irony in the growing divide between us. We all want the
same thing: the best care possible. But we have lost the ability to converse
thoughtfully with one another. And because of that loss, we can no longer
discuss the meaning of illness, care, health and policy in a way that is
relevant to all of us.

My hope is that we can revive that conversation. Not in a clinic or hospital
room, but here on the Web. Many of the topics I discuss will emerge from my
experiences in and out of the operating room, or reflect an ongoing policy
debate or fascinating research finding. Others, I hope, will spring from
your comments and unique perspectives.

It will be the shared insights from this online community, I believe, that
will begin to bridge the gap between patients and doctors and remedy the
disconnect.

It is difficult for any one of us to change today's health care system, but
there is one thing every one of us can do.

We can begin the conversation.

To join the discussion, click here to post your comments on the Well blog,
"Patients and Doctors Start Talking."

Pauline W. Chen, a liver transplant and liver cancer surgeon, is the author
of "Final Exam: A Surgeon's Reflections on Mortality" (Knopf, 2007; Vintage,
2008). This is the first of a regular online column, "Doctor and Patient,"
that will be appearing on Thursdays at nytimes.com/health.

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