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Doctors Tell All—and It’s Bad - Meghan O'Rourke - The Atlantic

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Doctors are failing us.

But this essay isn’t about how I was right and my doctors were wrong. It’s about why it has become so difficult for so many doctors and patients to communicate with each other. Ours is a technologically proficient but emotionally deficient and inconsistent medical system that is best at treating acute, not chronic, problems: for every instance of expert treatment, skilled surgery, or innovative problem-solving, there are countless cases of substandard care, overlooked diagnoses, bureaucratic bungling, and even outright antagonism between doctor and patient. For a system that invokes “patient-centered care” as a mantra, modern medicine is startlingly inattentive—at times actively indifferent—to patients’ needs.

To my surprise, I’ve now learned that patients aren’t alone in feeling that doctors are failing them. Behind the scenes, many doctors feel the same way. And now some of them are telling their side of the story. A recent crop of books offers a fascinating and disturbing ethnography of the opaque land of medicine, told by participant-observers wearing lab coats. What’s going on is more dysfunctional than I imagined in my worst moments. Although we’re all aware of pervasive health-care problems and the coming shortage of general practitioners, few of us have a clear idea of how truly disillusioned many doctors are with a system that has shifted profoundly over the past four decades. These inside accounts should be compulsory reading for doctors, patients, and legislators alike. They reveal a crisis rooted not just in rising costs but in the very meaning and structure of care. Even the most frustrated patient will come away with respect for how difficult doctors’ work is. She may also emerge, as I did, pledging (in vain) that she will never again go to a doctor or a hospital.

Spend a day in an emergency room, and chances are you’ll be struck by two things: the organizational chaos and the emotional detachment as nurses, doctors, and administrators bustle in and out, barely registering the human distress it is their job to address. The same could be said of our oddly bloodless debates about the future of health care. The rhetoric of medical reform draws mostly on economics: Experts differ over, among other things, how to structure “insurance mandates” and what constitutes “overutilization” of a rapidly expanding array of high-tech procedures and diagnostic tests. They argue about why “the United States health care system is the most expensive in the world,” as a 2014 Commonwealth Fund report finds, yet consistently “underperforms relative to other countries on most dimensions of performance.” (Currently, according to that report, the U.S. ranks last among 11 major industrialized nations in efficiency, equity, and “healthy lives,” meaning health outcomes attributable to medical care.)

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