292 Interacting with Their Patients
Though doctor-patient relationships contain important elements of aura
and magic, questions arose of whether at any point, increased awareness
of this magic could lessen its effects. It may be important that the
mystique of the healer not be entirely removed; but magic can be dan-
gerous and misused. In The Sorcerer’s Apprentice, failure to appreciate the
responsibilities, burdens, and potential danger of one’s magical powers
easily renders harm (2). Presumably, increased self-consciousness about
a physician’s own placebo effect would not necessarily dampen it, but is
there a point at which it might? Certainly, if it promulgates arrogance or
misuse among physicians. But these boundaries were not always clear.
Unfortunately, these issues emerged against the backdrop of growing
constraints on resources. A doctor may try his or her best, but patients
may remain frustrated or disappointed. At times, consumers may set
too high a standard—expecting doctors to have ample compassion and
time—while wanting to pay the least possible for care.
Better Systems and Policy
These doctors had critical suggestions for improving policy, yet means of
providing feedback to alter the system appeared scant. Nonetheless, even
simple, low-tech alterations may be helpful. For example, taboos against
physicians criticizing each other could impede improvements in care. Pro-
fessional hierarchy stymied complaints or efforts of trainees, who were less
socialized into medical institutions, and hence generally more open to, and
sympathetic with, patient perspectives. Trainees observed problems, but
felt powerless to change them. Repeatedly, potential benefits of a national
health insurance system became evident. Needs emerged to improve in-
formed consent as well. For example, Jerry felt that current policies and
policy debates about how much information to provide to patients in order
to obtain informed consent were not sensitive enough to the realities of
clinical practice. ‘‘Lawyers don’t realize that most patients don’t want to
know all the information. If you try to give it to patients, they’ll tune you
out.’’
Jerry and others saw needs for flexibility, and for improvements in
education about medical ethics and law.
I had no idea what the whole legal doctrine around informed
consent was, yet I was getting consent every day from patients. I
was probably doing things ok, but not discussing enough detail.