The Doctor-Patient Relationship Has Become Transactional. It Can Lead To Disastrous Consequences.

I love Bruce Lee. From his martial arts skill and athletic prowess to his philosophy, he was a cultural icon. There are hundreds of anecdotes and stories, some based in fact and others in fiction, that are a testament to the value he placed in the pursuit of knowledge, self-improvement, and being a life-long learner.

He once told a story about a college professor who visited a Zen master in hopes of learning Zen. Over the course of the conversation, it became clear to the Zen master that the college professor was more interested in asserting his own opinions and knowledge than learning new insights. The master continued to speak with him and finally suggested that they have some tea. The Zen master took the tea and poured and poured into the professor’s cup, eventually causing the cup to overflow. And still, he kept pouring. The college professor eventually spoke up and asked the Zen master to stop as his cup was overflowing. The Zen master then said, “Like the cup, you are full of your own opinions and speculations. How can I show you Zen unless you empty your cup?” The moral of the story is that preconceived notions and ideas can often prevent us from seeing the truth.

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This story speaks to me personally and professionally. As a physician, I am called to be a lifelong learner. This is why medicine is considered a “practice.” It can never be perfected. Knowledge changes as new discoveries are made. Old theories and practices are left by the wayside as newer, more evidence-based practices are pushed to the forefront. The minute I stop learning new information is the minute I fall behind, eventually falling out of what is considered the “standard of care.” I will probably look back at my career 30 years from now and think, “If only we knew then what we know now.” This is both a necessary and humbling realization.

To my patients:

Just as was required of the college professor in the story, please empty your cup. We live in a world where we have more access to medical information than at any other point in human history. You can google search your symptoms and get a list of possible diagnoses as well as likely treatments, all in a manner of seconds. Many of you bring these suggestions to your visits. This can create unreasonable expectations for the care you are to receive. In the highly litigious world we live in, where “patient satisfaction” plays a large role in system and physician reimbursement from insurances, physicians are put in the unenviable situation where we must balance your expectations for your care with what we consider to be safe.

According to Statista, 17 million prescriptions for Z-packs (azithromycin) were prescribed in 2018. Many of which were likely for mild upper respiratory infections and sinusitis. The Infectious Disease Society of America no longer recommends azithromycin as a treatment for bacterial sinusitis due to high resistance rates and lack of efficacy. Serious side effects from this antibiotic include heart rhythm abnormalities and liver damage. In the same vein, consider the medrol (methylprednisolone) dose pack. Many medical professionals have prescribed it for a number of benign medical conditions, including upper respiratory infections (the vast majority of which are viral), sinusitis, nerve entrapment, and general inflammation. Though not considered a high-risk medication by the public, prolonged exposure can cause elevated blood pressure, fluid retention, gastrointestinal bleeding, vision problems, bone thinning, and bone death (avascular necrosis).

Unfortunately, we live in an era where the doctor-patient relationship has become transactional. Instead of paying for a doctor’s medical opinion, we pay a fee for the doctor to prescribe the medication or order the test we think we need. This is a paradigm shift that can lead to disastrous consequences. When a patient comes in with fully-formed, preconceived notions of what they are suffering from, a barrier is created between the physician and the patient, which can be detrimental to proper and safe care. Whether this leads to improper prescribing of medication or unnecessary laboratory testing and imaging, harm can be caused to our patients.

It is a joy and a privilege to be called your doctor. I also consider it a huge responsibility to care for you in sickness and in health. My mandate as your physician is “first do no harm.” I promise never to stop advocating for you and collaborating with you. If you empty your cup, I will empty mine.

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