12 Introduction
genome, and baby boomers age and face more disease, the medical system
is becoming ever more complex and frustrating. Managed care continues
to spread and evolve, and debates about national health insurance boil
without clear resolution. Patients are becoming more educated consum-
ers, while the health care system becomes ever less user-friendly. Some
critics fear that trust in physicians is eroding, that doctors and patients feel
themselves to be antagonists, and that doctoring is becoming less of a
noble and respected profession, and more of a mere job.
Recent studies have highlighted several specific problems: for example,
how doctors and patients fail to communicate. Physicians disagree with
patients 50 percent of the time about the latter’s main problem (23), and
have difficulty discussing sensitive but important topics such as end-of-life
care (24). Providers may raise the topic, but often too vaguely. Physicians
miss important emotional cues (25) and have trouble talking about sexual
issues (26). Doctors and patients even disagree about the importance of
effective communication (27). Yet good physician-patient communi