Below, a guest-post by Dr. Clifton K. Meador, the author of well-known satirical writings on the excesses in our medical system, including “The Art and Science of Non Disease,” (the New England Journal of Medicine, 1965) and “The Last Well Person,” an essay he published as an “Occasional Note” in NEJM in 1994. HealthBeat readers may remember past guest-posts by Meador including “The Art of “Diagnosis” drawn from his book True Medical Detective Stories, and “The Unheard Heart: A Metaphor,”
In this guest-post Meador writes about the importance of listening to patients—something that often doesn’t happen in a 15 minute office visit. I’m hopeful that under reform, more and more doctors will be able practice medicine full-time, leaving billing, hiring and firing of support personnel ,and all of the other time-consuming details of running a business to others. Telemedicine also should open up some time: rather than coming in for a 15 minute appointment, patients who don’t have questions could ask for refills of routine prescriptions on the phone or via e-mail.
Eventually Health IT will be good enough that doctors will no longer spend hours tracking down lost Faxes. Finally, more physicians will be dividing their work with nurse-practitioners. In some cases, the nurse-practitioner might be especially effective when dealing with chronically ill elderly patients; in other cases he or she might excel in treating adolescents.
Ideally, restructuring how care is delivered will lead to longer appointments with some patients, giving the doctor the opportunity to truly listen—particularly when the cause of physical symptoms remains a mystery.
If a doctor had more time, what would he discover? Here, Meador offers what some may consider a radical thesis: 55 years of experience as a primary care physician, combined with studying the medical literature, has convinced him that “between 30 and 40 percent of first contact primary care visits are stress- related or are psychological in nature.”
I’m particularly intrigued by his description of “psychosomatic disorders” as described by Dr. John E. Sorno in The Divided Mind.
I haven’t yet read the book, but look forward to doing so. The reviews are impressive. As Meador makes clear, to say that an ailment is “psychosomatic” does not mean that “it’s all in your mind.”
Finally, Meador mentions that at this time, the medical profession denies the existence of psychosomatic illnesses. I’m baffled. Both life experience and years of reading have convinced me that mind and body cannot be separated. I’d be interested in hearing from other physicians on this point. — MM
The High Cost of Not Listening to Patients
by Clifton K. Meador, M.D.
Author: True Medical Detective Stories and Symptoms of Unknown Origin
Before we can understand the high cost of not listening, we need to examine in detail the diagnostic process. I am limiting my discussion to patients with chronic or recurring symptoms lasting several months. I am not discussing acute illnesses. They fall into completely different category.