- Pumping Irony -

PUMPING IRONY: A Matter of Trust

Only about a third of Americans say they have faith in doctors, a fact that may say more about the system than about the physicians.

Two people sit across from each other, one with hands clasped and one holding a clipboard.

Every six weeks or so, I pay a visit to a practitioner of Traditional Chinese Medicine whose task it is to monitor the functioning of my various aging organs. Dr. Woo does this in a way that would elicit skepticism from most innocent bystanders. While I lie on a massage table, she places her fingers on what I assume to be communicative parts of my body and pushes down on my upraised left arm. If she finds that my liver “needs some support,” she’ll send me home with a particular nutritional supplement; if it’s my spleen, she’ll give me something else.

I’ll be the first to admit that this seems to be a vaguely mystical way to practice medicine, but the process, known as Nutrition Response Testing, cured My Lovely Wife of an intolerance to eggs years ago, and I seem none the worse for its remedies since I adopted the protocol. Besides, there’s something about Dr. Woo that makes me trust her.

It’s not that I don’t trust My Beleaguered Physician, who does his best to handle his patient load at the neighborhood clinic I avoid unless I need a good ear-cleaning. It’s just that the system in which MBP operates doesn’t tend to instill much faith in the doctor–patient relationship.

A 2014 survey, for instance, found that only about a third of Americans trust doctors. Writing in STAT, Haider Warraich, MD, notes that the level of trust has fallen dramatically since the 1970s, when two-thirds of those polled found physicians to be trustworthy. Part of the problem, Warraich explains, is that doctors spend too much time filling out paperwork and not enough time interacting with their patients.

But other research suggests there may be other forces at work, as well. I was struck last year, for instance, by a Harvard Medical School study showing that heart-attack sufferers who happened to show up at a hospital when many “interventional cardiologists” were away at academic conferences were more likely to survive their treatment. The cardiologists who stayed behind, lead study author Anupam Jena, MD, PhD, explained in a statement, may have been better at nonprocedural care.

“If doctors focus their attention on a particular kind of procedure, they might not develop other clinical skills that are as important to influencing outcomes as is knowledge of a specific procedure,” Jena said. “Treating a cardiac patient isn’t just about cardiac issues — it’s about other factors that the patient brings to the hospital.”

Then there’s a Rutgers University report, released in April, suggesting that terminally ill patients who give their doctors decision-making authority tend to endure more aggressive end-of-life treatments than folks who make their own choices.

It’s a fraught relationship, explains University of Utah research scientist Angela Fagerlin, PhD, who led a 2018 survey that found that 60 to 80 percent of respondents kept information from their doctors. They lied about their diet and exercise habits and clammed up when they disagreed with their doctor’s recommendations.

When asked about their prevarications and reticence, study subjects explained that they didn’t want to be judged or lectured about their unhealthy choices. “Most people want their doctor to think highly of them,” Fagerlin said in a statement. “They’re worried about being pigeonholed as someone who doesn’t make good decisions.”

Or maybe they’re afraid of triggering a treatment protocol that may leave them worse off than if they had gone untreated. I’m never going to show MBP the evidence of Dupuytren’s contracture in my right hand, for example, because he’s going to want to fix it. When I show it to Dr. Woo, however, she simply declares it to be “interesting.” There’s probably some acupuncture thing she could do, but she trusts that I’ll ask for treatment if I need it.

Warraich, a cardiologist at Duke University Medical Center, contends that physicians — and the healthcare system in general — could learn something from nurses. “We must emulate how nurses came to be the most trusted professionals in the United States,” he writes. “Systems should be designed, technologies developed, and payments configured in ways that allow physicians to spend more time with their patients. Until that happens, we need to make whatever time we get count and really connect with patients.”

It’s a noble pursuit, certainly, but given the consequences of some of those connections, I suspect there are plenty of patients — including me — who will prefer to keep their distance.

is an Experience Life deputy editor who explores the joys and challenges of aging well.

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