Jewish World Review Feb. 7, 2002 / 25 Shevat 5762
http://www.NewsAndOpinion.com -- BECAUSE the company for which I work changed health insurance plans, I recently had to find a new doctor.
Many people can testify that this task often is terribly trying and produces unsatisfactory results. My experience, however, was different. My new doctor made it seem as if he really had time for my annual physical exam. He wasn't distracted, asked lots of questions, took lots of notes, paid lots of attention.
No doubt it helped that he'd been my physician for a year or two more than 20 years ago. And it helped that I'd known his mother when she was a school teacher. So returning to him wasn't like going to someone I'd never met. And it was clear that he had cared enough to have kept up with my life by the personal questions he asked.
I felt I was seeing someone who wanted to have a full picture of my life so he could help me stay healthy.
In fact, my experience was in line with what the University of Rochester (N.Y.) School of Medicine and Dentistry hopes will happen to everyone once medical schools change the way they train physicians. In a recent article in the Journal of the American Medical Association, two physicians from that institution outlined a new approach to producing caring, competent doctors.
Ronald M. Epstein and Edward M. Hundert say medical schools must create new ways of training doctors and assessing their abilities. The goal, they say, should be to turn doctors not into technical wizards who always lead with the head but, rather, into caring professionals who show some heart. Patients, they say, want trustworthy doctors who show good judgment, communicate well and stay up to date with their field.
"For patients," says Epstein, "it's not enough to know that their doctor scored well on a multiple-choice test."
The University of Rochester's medical-dental curriculum now uses this approach. For instance, in the Rochester system, students begin working with patients in their first year. Many schools delay student-patient contact until the second or third year of training. And at the end of their second and third years, Rochester students undergo a two-week assessment of professional competence, focusing on the people skills so necessary for good doctor-patient relationships.
Other schools, of course, say they try to create doctors with good bedside manner. And no doubt some succeed. But as health care in America has become more corporate, more insurance-driven, more cost- conscious, many patients feel like pawns in a game others are playing.
I've been fortunate over the years to have physicians and dentists with generally good people skills. And I was quite young when I learned to appreciate such people. I had pneumonia three times before I made it to fifth grade. It was an era in which family doctors made house calls. I still remember the gentle hands and soothing voice of Dr. Newton, and I came not to fear his coming with his black bag but to trust that he was doing whatever it took to heal me.
Later, when I spent two years of my boyhood in India, our family doctor was an American woman who had married an Indian and had blended into Indian society fully. She was a big-boned, loving woman who reminded me of my grandmothers. And when I had to take disgusting-tasting medicine to wash some disease out of my vulnerable young body, she was there to stroke my hair and wipe my face with a cool washcloth.
Even when, as an adult, I was a member of an HMO for 20 years, I felt I had good physicians with pretty fair social skills. But I know all kinds of people who haven't shared my history of good doctors. I've heard them tell stories of cold physicians who couldn't bother even to remember their names, of rigid stick figures who rarely made eye contact, of medical robots who wouldn't condescend to provide helpful information to help patients make difficult choices.
Just because someone is motivated to go into the healing arts doesn't mean he or she is born with the skills patients most want them to have. That's why I find it reassuring that people such as the Rochester physicians are worrying about this in public.
Let's hope America's vast medical education industry listens to