In the many years that Dr. Harvey Finklestein has managed pain for his patients, he has seen many changes. Some of the changes, like better medications and diagnostic technology, are beneficial. Others, like the doctor/patient relationship, have suffered.
The bedside manner of the medical professionals today is a far cry from that of the concerned, caring MDs portrayed on TV. There are many reasons for this decline in patient care, some technological and some the result of economics.
Treat Disease First
The training of doctors is one of the most complex and demanding of all the professions. This is why potential medical professionals spend from 7 to 12 years in study and internships. Medical students learn about the body, the diseases and the technologies and medicines that combat the diseases. What they are not taught, or even expected to learn, however, is how to treat a patient.
“The physician should not treat the disease but the patient who is suffering from it.” This quote from Maimonides, one of the greatest physicians of the Middle Ages, was the guiding spirit of medicine for thousands of years. The focus was more on the patient and how they reacted to the disease rather than the actual condition with which they were afflicted.
The Business of Medicine
For physicians today, the biggest enemy is time. It takes time to get to know the patient, time to learn about their lifestyle and environmental conditions. This time is now spent managing increasingly larger case loads, extensive insurance and governmental documentation, and keeping up with the latest in techniques and technology.
Most physicians today are professional corporations. They oversee a complex office and have a huge overhead to cover each month. To increase the time spent with a patient would mean less patients, which means less income. For young medical professionals still carrying a student debt in addition to the overhead costs the choice becomes routine.
When it comes to patient care Dr. Harvey Finklestein has an old fashioned belief.
“In order to give the best possible personal care to my patients, I have to get to know them as a person” he said. “When the care becomes less personal patients are not getting the care they need.”
Research backs up Dr. Finklestein’s personal belief. The study “Time and the Patient–Physician Relationship” in the Journal of General Internal Medicine found a correlation between the time a doctor spends with a patient and the number of prescriptions issued.
“Shorter visits, especially those less than 15 minutes, were a risk factor for inappropriate prescribing and management of gastrointestinal side effects,” the study found.
The evidence was startling. The less time a physician spends with a patient the more prescriptions were written. Drugs, it seems, were a replacement for a more thorough examination of the patient as a whole.
Personal Pain Management
Nowhere is there a greater risk of over prescription than in the area of pain management. With the variety of drugs and techniques available for treating chronic or severe pain, Doctor patient time can be limited to discussions of the medications. With so many pain options available the reason behind the pain becomes secondary.
“In my practice I deal with a lot of back pain, neck pain and nerve injuries,” Dr. Finklestein said. “Many of them are elderly or in distressing pain and it often takes more time to diagnose the underlying condition.”
He says medications are not the only treatment for chronic pain.
“Sometimes, after discussing their lifestyle and environment, a drug free treatment is preferable, but I would never know that without taking the time to ask questions.,” he said.
Much has been made of the advances in technology, both diagnostic and communication, that promise to free up time for the physician. Social media tools can provide patients with access to their Doctor from home. Diagnostic equipment can pinpoint a problem in ways previous generations of medical practitioners could only dream of.
The time saved however, is quickly eaten up with the time required to learn the new technologies and to operate them. A Skype call to the Doctor takes as much time as a regular visit and is less personal. The specialized diagnostic equipment is expensive and time consuming as well.
What technology has done is remove the contact between patient and physician from primary to secondary focus.
Trying to balance the demands of a busy practice with spending time getting to understand the patient’s problems and personality is one of the biggest challenges facing medicine today. With younger professionals busy getting established, an understanding bedside manner is often the first causality. For others like Dr. Finklestein, treating the patient will always come first.