The last time I wrote for KevinMD, I asked, “What happened to real care in health care?” I was tired of commercial after commercial promising that a new drug could fix nearly anything. I was frustrated by the steady stream of new labels and acronyms that sometimes make ordinary human struggles sound like conditions waiting for a prescription. That frustration was personal, but it was not entirely imagined. From 1997 to 2016, spending on direct-to-consumer prescription-drug advertising in the United States rose from $1.3 billion to $6 billion.
I still believe something is wrong when the newest medication receives more attention than the person who may take it. I still believe a patient should not have to compete with a computer screen to feel heard. However, I also need to admit when I am wrong. I allowed my frustration with the health care system to become a judgment about too many of the people working inside it.
Most recently, I have had the pleasure of seeing excellent physicians in my rural Illinois community. Dr. Workman and Dr. Ajdinovich, along with their staffs, took time to know me. They did not sit behind a computer and nod while I talked. They made eye contact. They asked questions. Most importantly, they made me believe they were listening. That may sound like a small thing, but it changes the entire experience of being a patient.
That experience matters more than patient satisfaction. A review of randomized trials found that the patient-clinician relationship has a small but statistically significant effect on health outcomes. Research on computers in the examination room also shows that technology can affect eye contact, information sharing, and the flow of conversation, although much depends on how a clinician uses it. A computer does not prove that a physician does not care. It is a tool. The problem begins when the tool becomes more important than the person sitting across from it.
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I am not asking medicine to return to some imaginary time when everything was personal and nothing was complicated. Modern technology identifies diseases that were once misunderstood and provides treatments that save lives. Electronic records can make important information available in seconds. New medications can be genuine breakthroughs. Progress is real, and patients benefit from it every day.
Still, advertising volume is not the same as medical value. A study of the drugs most frequently advertised on television from 2015 through 2021 found that fewer than one-third were rated as providing high therapeutic value over existing treatments. That does not mean the remaining drugs were worthless. It means patients rarely see the same balanced comparison they would expect from a trusted clinician: What does this drug do better? What are the risks? Is there an older or less expensive choice that works just as well?
The profession must also take financial relationships seriously. A systematic review found that payments from pharmaceutical companies were consistently associated with greater prescribing of the paying company’s drugs, higher prescribing costs, and increased use of brand-name products. An association does not prove that every physician is intentionally putting money ahead of a patient. It does show why transparency and honest conversations matter.
My first point is simple: I was wrong. Exceptional doctors still exist, including in rural communities where resources are limited and the workload can be overwhelming. My second point has not changed: Patients need professionals who will look beyond the advertisement, explain the choices, and listen before deciding. Real care has not disappeared. I know because I have experienced it. The challenge is making that kind of care ordinary rather than exceptional.
Christopher H. Foster is a director of emergency services.fos
