Northeastern Illinois University
Changes in healthcare over the past half century have altered the dynamics of the psychology of the patient/ physician relationship, resulting both increased patient suffering and moral distress among caregivers. It is the premise of this paper that this discord is now dissipating as both patients and caregivers are seeking a return to more compassionate medicine.
A construct of societal changes have caused health care to evolve. In the last 20 years the patient /physician relationship has shifted from that of a trusting long term relationship to one of frustration and alienation. Historically medicine has shifted in the past century from home based medicine to institutionalized medicine. Previously, family members tended to the ill as best they were able with the resources they had in their own homes. Physicians, when they were involved at all, commonly made house calls. Babies were most often delivered at home and most patients died at home rather than in the hospital. Interestingly, in his book Illness and Culture, (1998) David Morris contends that changes in medical care response came about as a response to the postmodern era. He sees illness as a societal state of affairs. As hospitals grew in number medical care slowly became more institutionalized. Initially the physician patient relationship remained unchanged. In his article Modern Technology and the Care of the Dying ( Thomasma & Kushner, 1996). Ronal Cranford suggests that by the 1940’s patients began to have greater access to neighborhood doctors. Typically these doctors had a standing relationship with patients for long periods of time, and the same physician cared for most family members. Services were provided on a self-pay basis by patients. Sometimes payment included the barter system, and it was not unusual for doctors to offer charity services. The result of this relationship was one of trust, and mutuality. Most patients revered their doctor’s judgment. Conversely, physicians were familiar with their patients and their healthcare wishes. During ones final days the patient was surrounded at home by family and friends and a family practitioner who knew them and their family wishes well (Thomasma & Kushner, 1996). Contrast this physician patient relationship, with today’s healthcare environment. More commonly, most patients die in the hospital. Prior to their deaths they are cared for institutionally and less by family members ( Thomasa & Kushner, 1996). Some of this shift came about with the changing roles of women, and economic forces that have required two family incomes. Compounded with other significant factors which will be detailed in this paper, the result has been a shift in the patient/physician relationship. An appropriate starting point is the consideration of the historical transition that led to this shift. A number of factors have influenced the shift in healthcare dynamics that we have experienced over the last half century. These factors are varied, including societal, economic, political and cultural perceptions, to name a few. For the purpose of this study, the focus will be on two of the more profound influences: technological advances and the shift in reimbursement dynamics. Perhaps most profound in the shift in health car dynamics have been the advancements in technological and pharmaceutical capabilities have impacted patient outcomes and expectations. Technology has now given us the ability to sustain life at the risk of reducing quality of life. According to Ronald Cranford, (Thomism & Kushner, 1996), the tradeoff has been both good and bad. Modern medical treatments and modalities mean that life no longer seems to have a natural end. Therefore, family members feel cheated. Likewise, doctors view death as defeat. We have become creatures of modern technology (Thomasa & Kushner,...