Losing Trust in Medicine

People are losing trust in medicine. This is a very bad thing. And doctors are taking note. From a column by a surgeon named Pauline Chen published in the New York Times:

“I don’t rely on the doctor anymore. These days, you have to look out for yourself.”

Those words, and the smell of grilled meats, wafted by me at a recent potluck dinner party. My husband and I had tagged along for a summer reunion, where my sister-in-law and her husband joined a group of 40-, 50-and 60-somethings who were visiting their hometown, eager to catch up on their childhood buddies’ lives.

The chatter started as one would expect—five-minute recaps of work, children, parents and summer plans. But as the evening progressed, the gossamer conversations of this boomer crowd seemed to spin into one thread: the state of one’s health. Or our parents’ health. Or our children’s health.

And no matter the specifics of each story, they all seemed to revolve around one theme: that as a patient or the family of a patient, you would feel at odds with the very people who were supposed to care: the doctors...

More and more Americans feel disconnected from their doctors, especially compared to a generation ago. And they certainly have less confidence in the profession as a whole. In 1966, a Harris Poll found that almost three-quarters of Americans had “a great deal” of confidence in their health care leaders. That number has steadily dropped over the last four decades, so that today only slightly more than a third feel the same way, the same poll shows.

Alas, the column doesn’t really explore the reasons for this verity, although she hopes to have further conversation about that with readers of the NYT Web site.

I suggest the conversation could look into these issues for a start:
1. The erosion of Hippocratic values caused by the influence of utilitarian bioethics leading toward a “quality of life” ethic that devalues the sickest patients and those with cognitive and developmental disabilities.
2. The erosion of Hippocratic values caused by the influence of HMOs and the capitation system of medical economics that result in hospitals and doctors losing money on the sickest patients or those with the most serious disabilities.
3. Bioethics agenda items like futile care theory in which people see stories of doctors trying to refuse wanted life-sustaining treatment.
4. The drive for health care rationing that would be medical discrimination by a more polite name.
5. The erosion of trust in ethical end of life care sowed by the assisted suicide movement.
6. Controversies like the Terri Schiavo case in which some people see a helpless woman dehydrated to death by doctors who willingly remove sustenance and others see a woman forced to remain alive against her wishes in a condition they dread befalling themselves or their loved ones.

I am interested in any of your thoughts on this important matter.