Why are my interactions with my physician the way they are?

Many people have had the experience going to their doctor with multiple complaints and symptoms, and the doctor only addresses one or two of these and is unable or unwilling to look at the whole picture. There are several reasons for this.

First: is that physicians are mostly trained in symptom oriented and organ based (cardio-vascular, neurological, muscular-skeletal, gastro-intestinal, etc.) diagnosis and treatment (we look where they pain or problem is). The model of assessment and evaluation cannot bring all these issues together and look at them as a whole.

Second: is the fact that medical science and education is much better at diagnosing ‘pathology’ (finding tumors, damaged organs, blocked arteries etc), then at evaluating symptoms related to everyday human functioning (why am I so tired, depressed, constipated, allergic, foggy-minded, etc). It happens so often that people go to the doctor with complaints of fatigue, depression, insomnia, pain, digestive problems and others, that after the doctor evaluates them and does tests, they get the ‘good’ news that nothing is wrong. The symptoms however are still present and one ends up with pain pills, anti depressants, laxatives, allergy prescriptions etc. This is a band-aid at best but rarely a satisfactory restoration of health and wellness. 

Third: is that physicians don’t have the time to study different models of assessment, and don’t have the time with you in the exam room to apply those if they would want to (5-10 minute visits). They are very restricted by required (and mandated by insurance companies) models of approach and reimbursement rules (they won’t get paid for the extra time they spend with you, especially the primary care physicians). Reimbursement for medical care in our country is very procedure oriented (when the doctor does things to you, like tests and surgeries) and not for actual times spend with the patient (when the doctor tries to get to know you and figure out what to do). In short, tests and procedures pay, listening and thinking don’t. (a recent article in the AMA newsletter send to physicians mentions that the average cost per doctor for dealing with health insurance companies is nearly $70.000/year, or $23.2 billion to $31 billion for all physicians together. Source: “What does it cost physician practices to interact with health insurance plans?” HEALTH AFFAIRS, May 14, 2009). I do not think that a national health plan will improve that.  

Fourth: The worry and fear for lawsuits or loss of their medical license has an enormous effect (often unconsciously) on physicians practice and the way they evaluate and approach their patients. This is currently an unavoidable aspect of healthcare in the U.S. but has great consequences for the healthcare you get and the costs associated with it. It definitely does not invite creative and individualized thinking in your doctor, and you probably don’t get the best of his/her talents and experience. To figure out what’s wrong often cannot be done within the limits of ‘standard of care’. This does not mean that physicians and health practitioners should not be held accountable for the evaluations, advice and treatments they give, but the fear for excessive consequences for making a possible mistake or stepping out of line puts great constraints on your interactions with him/her.