“The patient is the one with the disease.” This medical aphorism, often quoted as rule number four from Samuel Shem’s 1978 novel, The House of God, has probably been around as long as medicine itself. Its point is that doctors need to learn to accept their own vulnerability and fallibility before they can devote themselves fully to the care of their patients. And so long as medicine was built on the relationship between two parties, patients and doctors, the rule worked reasonably well.
More recently, however, the party is being transformed into a crowd. A third player is increasingly encroaching on the doctor-patient relationship, and more and more doctors are beginning to suspect that it may be the vector of much of contemporary healthcare’s pathology. Who is the third party? Its precise identity is often difficult to pin down, but its seat in the doctor’s office and at the patient’s bedside is often occupied by a hospital, a health insurer, or a government agency.
This third party usually does not see individual patients. Instead it sees aggregates, such as rates of mortality, disease incidence, and the utilization rates of particular tests, procedures, and pharmaceuticals. It tends to be particularly interested in parameters such as efficiency, safety, cost, and revenue. Because it is largely blind to individuals, however, its risk of developing certain disorders is dramatically increased. And when it falls ill, both patients and doctors suffer.
Before patients and doctors can respond effectively to such pathologies, they must first recognize that they exist. One of the first steps in recognizing a disorder is applying a name to it, and one physician who has taken up this challenge is Adam Ratner, MD, one of the founders of the San Antonio-based non-profit, The Patient Institute. Ratner, who has been struggling to clarify the nature of these pathologies for many years, believes that healthcare is in the midst of an unrecognized epidemic.
