Last week my nurse called me, weeping. A patient had called and abused her, threatened her, and said he would complain to authorities about her. This, because his insurance company had delayed his medication refill request by a week. My nurse was hurt; she answers patient queries and emails even on her days off. He is not the only one shouting at and threatening medical staff. In my 30-year career in medicine, I am seeing the trajectory of rude, combative, and aggressive patients rise rapidly. Yesterday, a young woman whom I had called in (for a free visit) to discuss her complex, but thankfully, all normal results snapped at me, saying she didn’t need to come in to discuss normal results. I was taken aback by her rudeness. I prefer to discuss complex results in person for various reasons, but in our time-strapped world, people want an email or a quick message. Our time-tested protocols, which ensure patients fully understand their condition and we have communicated properly, are being abandoned. Patients are not satisfied because the world is changing, and they need quicker, faster, more efficient responses in a world that can answer all our questions at the touch of a button. Is their rudeness and impatience a sign that they want faster and better care? How do we deal with this? Do we modernize medicine?
Medical professionals sacrifice a lot. We give up our weekends and holidays; we come in to work when our kids are sick because there is no one to take our shift; we delay lunch and bathroom breaks. During COVID, while the world stayed home, we went to work every day. Is this sacrifice necessary or appreciated? Should we abandon the caring and compassionate niche and treat medicine like other services? Like a fast, efficient restaurant, for instance? No need to build relationships or care about poor outcomes? Just follow the protocols. Let us not cry over a patient who dies unexpectedly or the one who experiences that rare drug adverse event? Are the old ways neither time- nor cost-effective?
With the advent of AI, this may be where medicine is headed. Bright rooms where the intake has been done by a computer and where symptoms and labs have been uploaded. The algorithm then spews out the protocol, and follow-up workup or medication needed is recommended. The physician or provider checks this, spends 5 minutes confirming everything, and sends the patient on for their next steps. Third-party payors are part of the agreed algorithms too, and there are no delays. Maybe the patients can even do much of this online, and there is no need for them to commute and spend time waiting in doctors’ offices.
However, I know most of my patients so well, I will miss our chats and connections. I will miss the cookies and flowers, the little thank you notes. But it is inevitable. Artificial intelligence and cost inflation, patient expectations, and pressures from third parties are leading to “McMedicine.” Fast, palatable, but maybe not the best for your health. Some patients will get what they want—quicker, perhaps more accurate results. This may provide better access to care for millions of people. But I believe that some will need the fine medicine experience, the relationship with their doctor, the slow physical exam, the conversations, and the hugs. Because some, like me, believe that it’s in the moments between the history and physical exam, between pecking out orders on the computer, when the physician turns to look at the patient and ask about their lives—somewhere in those undefined moments is when healing happens.
Humeira Badsha is a rheumatologist.
