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Dialogues@RU is published annually
by the
Writing Program at
Rutgers, The State
University of New Jersey
Volume One
Spring 2002
The Routinization
of Health Care and the Professional Calling -
Page 3
by Megan H. Johnson
This growing divide between health care providers and their patients, and in a larger sense, the divide between these workers and the "greater community" of which they are a part, commonly occurs in other spheres of the health care industry, as doctors are also faced with the reality of spending less time with patients as a result of the influence of HMOs on their work. In his article entitled "The Single-Doctor HMO," Steve Lopez conveys the experience faced by disgruntled patients everywhere, as he describes a typical visit to a doctor's office in post-HMO society:
If you've visited a doctor anytime recently, you know the routine. You wait an hour for a 10-minute once-over, and you can't get an aspirin tablet or a Band-Aid-- let alone a referral -- without six bean counters and a dozen paper pushers eyeballing your entire medical history. (8)
This patient's experience is probably becoming more and more common in the wake of HMO intervention in health care, as doctor-patient interactions are limited in a variety of ways. This scenario illustrates the frustration many people feel when they are faced with the constraints brought about by HMOs, such as having less time to develop a trusting rapport with their doctor, and being forced to spend more time dealing with bureaucracy and paperwork. This particular patient actually characterizes modern doctor visits as "routines" instead of spontaneous interactions, reflecting the trend towards lackluster, disconnected physician-patient relationships. Lopez' conveyance of the current prototypical relationship between doctors and their patients as a "routine" in which anonymous "bean counters and...paper pushers" interfere, describes the limits HMOs place on doctors' attempts to reach out to the "larger community" in a manner befitting Bellah's description of a calling. This new reality is also extending beyond traditional doctor-patient relationships, as recent studies suggest a troubling trend related to the percentage of doctors who provide charity care in their communities. The numbers of physicians who do so dropped four percent between 1997 and 1999, with experts tying the decrease to "changes in the medical marketplace, including an increase in managed care and the trend away from physician ownership of practices during the 1990s" (Romano 12). In "Managed Care: Business as Usual," Eva Havas suggests that the best way to appraise the effect of managed care is to gauge the sense of alienation that currently pervades medicine and affects the quality of care that people receive. Havas addresses the dangers of weakening the doctor-patient relationship, stating that:
To the extent that the relationship between patient and provider becomes adversarial, the cooperation that is key for compliance with "doctor's orders" is lacking, as is the discourse necessary for accurate diagnosis. Moreover, an adversarial relationship - or no real relationship at all - adds stress to the patient despite our knowledge of the negative role of stress in both causing and exacerbating illness. (81)
While changes in health care may bring emotional stress to both health care providers and their patients, this quote raises the notion that the consequences could reach even farther, affecting the actual physical health of the greater community. When the interaction between doctor and patient is strained, Havas suggests that the patient's willingness to adhere to the doctor's orders declines, and that the possibility for even an accurate patient diagnosis is diminished. So while the regulations and resultant "routines" imposed by HMOs may be good for business, they don't appear to benefit the health of the community. This newly "adversarial relationship" between physicians and their patients apparently only "adds stress to the patient" and decreases the ability of the doctor to get involved with patients' lives, possibly clouding his or her view of work being a calling, a "crucial link between the individual and the public world" (Bellah 66). The onset of a nursing shortage and the influence of health maintenance organizations are evidently a part of a trend in which work's connection to society is decreased, as these changes in the health care industry are diminishing the relationship that doctors and nurses have with the greater community.