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A matter of trust
Written by Jeffrey R. Waggoner, MD   
Dr. Jeff Wagonner 

Assume for a moment that you know nothing about medicine. You have a headache that has become intolerable. It is unrelenting. You’ve had it for week. It began as mild ache at the back of your neck, but you initially paid little attention to it. You had spent a long day at your computer working on an important project with an imminent deadline. You often finished such days with what you called “computer neck.” No big deal.

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The headache had gradually spread from your neck to your forehead. Your project had fared no better. The pain worsened. The deadline approached. You had taken every imaginable across-the-counter pain medication. Two days earlier, you found yourself unable to eat—but you still managed to drain the coffee pot three times. The deadline was even closer.

Now, you’re vomiting. The project is due the next day. Your head is pounding. In desperation, you go to the emergency room. It’s packed. You sit and suffer, wait and fume. When finally seen, the emergency room doctor listens to half your story, does a brief exam, and tells you that you have a tension headache.

At that point, what do you suppose might happen? If you’re the patient, will you nod, slap your forehead, and say, “Of course! What a fool I am. Thanks Doc,” dig deep for your hundred dollar co-pay, and head home instead of back to work, assured that there is nothing seriously wrong and now aware that only a good night’s sleep will make things better?

Probably not.

In all likelihood, you will either leave feeling absolutely no better, perhaps to return to the emergency room, perhaps even that evening, or, you will demand that some other testing be performed—like an MRI. Both possibilities are inefficient. Both possibilities are expensive.

In a perfect world, both possibilities are also unnecessary because the most appropriate disposition for this problem would be for the doctor to listen to your entire history, commiserate with you, explain what is probably going on, discuss immediate options for pain relief as well as how overuse of pain medications has fried your stomach, and outline a well defined pattern of follow-up and what symptoms should bring you back ASAP. Will this happen in this world?

Probably not.

It won’t happen because trust is no longer a viable part of our health care system. Patients do not trust doctors. They don't know them. Doctors don't have the time to honestly listen to their complaints. Patients feel demeaned and degraded. Medical humanism is an endangered species. When technology is the only available aspect of the “miracle of modern medicine,” that’s all patients have to trust. Thus, the inevitable request--“Do another test. Order an MRI.”

And doctors? They really don’t know their patients. They do not have the advantage of long term healer/patient relationships nurtured by continuity of care. They are left wearing white coats stained by cynicism and muttering, “If you don’t give patients what they want, they’ll sue you. Better do an MRI to cover your... ”

Trust.

Our health care system must realize that trust is not a warm fuzzy. It is not just a bow that tree-huggers would like to tie around the trunk of medical care. Without trust, health care costs will never be controlled because technology, educational websites, and complicated systems cannot replace it.

The use of these things as a substitute for trust is incredibly expensive and absolutely inefficient. It’s also bad medical care. People need to trust their medical care to invest in it. Last time I checked, all my patients were people.

About the Author

J.R. Waggoner, M.D. practiced family medicine for thirty years in Aurora, Colorado. He also worked as a consultant and herded cats as the managing general partner of a general partnership of physicians. Three years ago, he left his practice to study health care policy and write. During his time away from clinical work, he has written two books and worked as a Senior Clinical Content Specialist and freelance writer.

His current book Medical Metamorphosis: The three step cure for America's health care crisis is available at Lulu.com.

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