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Spence Perry: 'Health care workers rethinking approach'

May 08, 2012

How long has it been since your doctor asked, “How do you feel?”

For many American patients, this has become a seldom-asked question. Patients are more likely to be greeted with a statement of laboratory results. And if they are within normal limits, an assumption often is made that everything is fine.

Doctors are less likely to touch their patients today, and many of them know less about their patients’ daily lives. This does not mean physicians are cold or uncaring (they might be rushed because billing standards strictly limit their time with patients, and to make an adequate income they must keep on task).

To their credit, doctors know this demolished level of patient contact is a serious problem. In the last few years, I have had more than a few regrets expressed for the bum’s rush in the examining room. And not only are doctors not content with the state of practice, they are doing something about it.

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Some doctors are cutting back their patient loads, so they will have a better quality of practice and life.

Often this means higher fees and co-pays, but reports are that there is a strong and growing market for increased sensitively and fuller explanations of medical issues.

This expanded treatment time can be particularly important for older patients who often have more than one serious ailment and who are taking multiple medications.

However, children and parents often need this kind of response from their doctors for pediatric conditions.

Of course, it goes without saying that time is important in cases dealing with mental illness. While greatly improved  drugs have diminished the need for years of talk therapy, these are indications that the lack of interaction might have gone too far, and there is some rethinking of the balance between drugs and conversation.

The entire health care field is going through a rethink of its approach. If doctors at the top of the food chain are increasing patient time and exposure, the lower ranks likely will follow suit. Medicine especially in a hospital setting is more hierarchical than the military or the church.

Thus, you see ads from drug chains for the warm extensive counseling of their pharmacists and from hospitals on their spa-like atmospheres. Even dentists claim to offer warmth and tender handling.

Perhaps the most dramatic move away from allocational care surrounds that most emotionally powerful, and in some ways most complex, of medical experiences — death and dying. The hospice movement founded in England just after World War II has experienced explosive growth in the United States.

Medical and religious reluctance has melted in the face of public demand. The hospice way — which is intensive in its human dimension — now takes place in hospice houses, the hospice-run sections of hospitals and, most often now, in the home, where hospice offers a family assistance with care medications, equipment and medical counseling.

The trend in medical care is away from distance and rationed emotional empathy on the part of caregivers and toward more discussion and more mental awareness on the part of those giving and receiving care. This approach might well enhance the effectiveness of active treatments and will certainly help those facing the ultimate journey to the “good death.”

There is, however, a potentially serious blockade in the way of this pattern of innovation. It is far easier to effect the new and different when there are a variety of competing payment sources operating under their own regulations as opposed to one dominant source of payment. After the Supreme Court speaks at the end of June, assuming the health care legislation remains largely intact, it will be important to ensure the new reality allows American medicine to continue to explore those hopeful recent approaches to care and comfort.

Spence Perry, a resident of Fulton County, Pa., is active in Washington County affairs.

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