By: Marvin J. Stone | MD, MACP, FRCP
The doctor-patient relationship has changed over the past 75 years. Collegial attitudes have largely replaced paternalistic ones. The moral standard of patient autonomy has emerged as a guiding principle of medical ethics. And, although scientific knowledge is vastly different than it was 100, 50, or even 10 years ago, the reaction of patients and families to illness hasn’t changed much at all.
“One of the things I’ve learned in 40 years is that our emotions are exactly the same,” Dr. Jimmie Holland, founder of the field of psycho-oncology, said. “They haven’t changed one iota over millennia. It’s fear. It’s worry. It’s what’s going to happen to me and what’s going to happen to my family…What the patient has always wanted and still wants is to know that this doctor cares about me.”
What will happen to the doctor-patient relationship over the next 30 years? Some clinical, educational, and research areas of medicine that are particularly important to address are as follows:
Access to care is a major problem. Universal comprehensive health care must be made available to all; medical care is a right, not a privilege.
The United States provides the most expensive — but not the best — health care in the world, as seen by our rising infant mortality rates and falling life expectancy. Inequities in access to care exist throughout society and have to be remedied. This is the top priority.
Other changes affecting the doctor-patient relationship include the use of telemedicine and the expansion of virtual doctors’ visits. Whether quality of care will improve as a result remains to be seen.
Concierge medicine will increase for those who can afford it, but the role of artificial intelligence (AI) in medical care remains undefined. Preliminary experience with AI in medical diagnosis and treatment has been disappointing, emphasizing that there is not yet a substitute for the discretionary judgment physicians bring to patients.
Student debt for medical students should be reduced or eliminated.
By the time of graduation, many students owe more than $200,000. Debt has significant adverse effects on medical students, affecting their choice of career and contributing to burnout from stress.
Shortening the length of medical school or implementing a US Medical Corps could be possible ways to eliminate debt. Free tuition is another solution.
Despite financial barriers, it is reassuring that applications for medical school continue to rise in the United States.
Currently, six million individuals are afflicted with Alzheimer’s or other dementias. The incidence of these diseases is estimated to rise to 15 million in the next 30 years. Currently we have no accurate diagnostic method before death, and no therapy has been shown to be reproducibly beneficial.
Unless significant breakthroughs are made, dementia patients will flood the healthcare system in the future. The social, ethical, and economic consequences of this epidemic will have enormous effects on society and the doctor-patient relationship.
Other major areas for future research are targeted therapy and gene editing. Targeted therapy for cancer and other disorders will expand, and treatment efficacy will improve with fewer adverse effects. Cures of diseases that have never before been possible will be realized using the revolutionary Nobel Prize-winning CRISPR technique. Doctors must keep up with the accelerating advances so patients will benefit.
The doctor-patient relationship will continue to evolve. But what will always remain is the need for physicians to cure sometimes, relieve suffering often, and comfort always.
This article has been adapted from Marvin J. Stone’s book, When to Act and When to Refrain, published in 2020.