Tom, a doctor friend, recently told me he was reprimanded by Michael, his hospital’s medical chief of staff, after two patients lodged complaints against him.
One instance involved a man whom Tom informed of a cancer recurrence. When the man cried, Tom put his hand on the man’s knee, attempting to comfort him. However, the man didn’t find it comforting. He said nothing to Tom but complained to administration, stating that the touch was unwelcome and made him feel worse.
The other instance was with a woman whose abdomen he felt for an enlarged spleen. “She seemed surprised,” he recalled. “I explained to her that this was a necessary part of her physical exam.”
Michael told Tom, “It was all I could do to keep the risk management team at bay. You need to understand, Tom, that it’s a different world now. People are edgy. And litigious. I wish it were otherwise.”
Tom said, “Are you kidding? Are you advising me not to touch my patients?”
“More than advising, Tom. It’s not me, it’s the bean counters in the Chicago head office. We both know that their priority is keeping out of court. I’m on your side; I probably would have touched those patients, too. Look: why don’t you just ask first, like, ‘Would it be okay if I touched you?'”
Tom replied, “That’s awkward. My patient was crying, and touching him was my spontaneous reaction. I’m human, too. I would’ve felt awful holding back, acting against my feelings.
“And that woman I examined. Doesn’t she know doctors routinely touch people, even stick their fingers into them? Didn’t she sign a form giving me permission to do what’s necessary to diagnose and treat her? I mean, medical practice is necessarily intimate. I wouldn’t invade her space frivolously, but asking if I can palpate her belly feels distancing, as though I’m a total stranger.”
Tom is sixty-three years old. He had planned on practicing well into his seventies, but now entertains misgivings.
An AMA report published in 2022 said that one in five physicians predicted they’d likely leave their practice within two years. This exodus, far greater than historical rates, isn’t explicable either by more advanced age or the Covid pandemic. They cite burnout, pressured work atmosphere, inordinate paperwork, and creeping control of their relationship with patients.
All these problems are traceable to a single source, the medical profession’s hijacking by business interests. Almost three-quarters of doctors are now employees of profit-driven private equity firms whose members call the shots.
If Tom retires early, it’ll probably result from his anger at interference between him and his patients. It might seem that such overreach is illegal, and indeed, California law prohibits doctors’ employers from dictating medical procedures. But ironically, touching patients might be regarded as extraneous to standard practice.
When I was facilitating cancer support groups, I was directed to get malpractice insurance. I responded that I didn’t feel I needed it. After all, I didn’t make diagnoses or treat with medications or procedures. I only sat, listened, and offered an occasional question. Certainly, I concluded, that can’t be construed as the practice of medicine. That reasoning found favor, so I was excluded from the requirement.
Actually, I didn’t believe my argument. I believed, then and now, that sitting, listening, and asking the right questions is the absolute nucleus of medical practice.
I’d like to urge my friend Tom to make the same argument with the bean counters in the Chicago head office, but I doubt they’d go for it.
Jeff Kane is a physician and is the author of Healing Healthcare: How Doctors and Patients Can Heal Our Sick System.
