The Heart of Medicine by Svetlana Kogan, M.D.

When I think of the strengths of our conventional Western healthcare, several things come to mind. Among them: amazing robotic surgical advancements, trauma care, and availability of sophisticated diagnostic radiology. However, the areas where it seems we fall short of our potential are prevention and chronic disease management. If we use the acute care model to name a diagnosis and right away look for a medication to treat it, we will have missed the patient’s whole life story. That story often never gets a chance of being heard, while, it almost always points to the root cause of the presenting illness.

The “Name it, Blame It, Tame it” medical care model is one of the reasons while our healthcare spending is projected to grow at an average annual rate of 5.4% reaching 6.2 trillion dollars by 2028. Indeed, we have the highest health expenditure per capita of any civilized nation in the world.

In this present healthcare paradigm, 55% of Americans take at least four prescription medications a day and the rates of obesity, hypertension and diabetes are rising in our country at unprecedented rates.

Since the days of my emigration from Ukraine in 1986, I have observed a rapid deterioration of the heart of our medical establishment. Doctors’ time spent with the patients became infinitely devalued by insurances and this became a no go for doctors taking their time to really listen to the patients. In a recent study of American women physicians, 75% said that managed care had a negative impact on their practice of medicine, while 77% were fatigued and burned out. The top reported causes of burnout were having too many bureaucratic tasks, lack of autonomy, lack of respect from administration or staff, government regulations, and insufficient compensation.

A doctor who is inundated by all of these woes, is unlikely to be able to practice compassion and serve the patient’s complex needs instead of trying to quickly fix them. For doctor-patient relationships to work, time spent with each other matters.

There are many chronic diseases where listening to the whole story is of paramount importance: high blood pressure, depression, acid reflux, migraines, irritable bowel syndrome, elevated cholesterol, autoimmune disease, and chronic fatigue, to name few. Instead, patients often feel rushed and not heard. I was recently creating a detailed timeline of my 76 year old patient’s chronic illness from her childhood to the present, when she started crying and confided in me that no one has ever asked her before about all these past nuances of her life.

Patients are also extremely sensitive to how they perceive their doctor’s attitude towards their illness. And this perception affects healthcare outcomes. In fact, a recent study found that the less empathetic and less thorough the doctor was during the encounter – the longer the duration and severity of the illness lasted. Interestingly, in that same study, not seeing the doctor at all was better than seeing a doctor who was perceived to be overly quick and non-empathetic by the patient!

Before the heart of medicine is lost, we should focus on compassionate health care in which we listen intently to the patient’s story and design the healing protocol in the context of the patient’s daily living situation.

Physicians who partner with their patients in addressing social and emotional aspects of chronic illness, have better outcomes in patient anxiety, function, symptom improvement, blood pressure control, sugar control and pain management. This doctor-patient partnership and collaboration is the heart of medicine which we should strive to preserve.

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