Medicine today values intervention far more than it values care. Gawande writes that for a clinician, “nothing is more threatening to who you think you are than a patient with a problem you cannot solve.” The result is that all too often, “medicine fails the people it is supposed to help.” The old doctor-knows-best ethos was profoundly flawed. But it was rooted in an ethic of care for the whole person, perhaps because physicians, less pressed for time, knew their patients better. Danielle Ofri notes that it was the paternalistic old doctors, still hanging around her medical school wearing “starched shirts [and] conservative ties,” who taught her the art of respecting her patients’ individuality: “For them, approaching the bedside of a patient was a sacred act.” One day she had a class with an intimidating cardiothoracic surgeon. To her surprise, he was as tender toward his wards as he was gruff toward his students, who, he insisted, should always seat themselves at the level of the patient or lower. “They are the ones who are sick,” he emphasized, “and they are the ones running this interview, not you.”
In the course of our lives, most of us will urgently need care, sometimes when we least expect it. Currently, we must seek it in a system that excels at stripping our medical shepherds of their humanity, leaving them shells of the doctors (and people) they want to be, and us alone in the sterile rooms they manage. What makes our predicament so puzzling, and what may offer hope, is that nearly all of us want a different outcome. I used to think that change was necessary for the patient’s sake. Now I see that it’s necessary for the doctor’s sake, too.
