Pauline W. Chen: A Surgeon's Reflections

Does Oversight Threaten the Doctor-Patient Bond?

Last week, President Obama signed an economic stimulus bill that sets aside $1.1 billion for comparative effectiveness research. Critics warn that the studies supported by this provision will lead to a one-treatment-fits-all-individuals approach to health care. Moreover, they believe that the government will unnecessarily insert itself into the doctor-patient relationship, deciding what is or is not "appropriate" therapy.

In this week's "Doctor and Patient" column, I write about comparative effectiveness research, third party oversight and their effects on the interactions between doctors and patients. Are there only two individuals -- the doctor and the patient -- involved in every clinical relationship? And does third party oversight supported by evidence-based research necessarily weaken the doctor-patient relationship?

I always learn from reader comments, so I'd love to hear what you think. Please leave a comment below or on Tara Parker-Pope's "Well" blog.

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I just joined Twitter and hope you will join me there, too.

Getting off the Patient Treadmill

Not too long ago, a friend and I were discussing pay-for-performance payment plans and their effect on the doctor-patient relationship. This friend is a primary care doctor, one of the best and most devoted patient advocates I know. His group recently signed a contract with their state's largest insurer that will reimburse them according to a pay-for-performance model.

I asked him if he was happy with the contract, and his response was that he couldn't see any other way of controlling spiraling health care costs. But he was concerned, too, that his patients might view him differently now. "If my patient comes in with a headache and wants a CAT scan, but I don’t order it because I think it’s not medically indicated," he said, "will that patient think I’m just trying to save money?”

This week in "Doctor and Patient," I write about the surprising lack of high quality clinical studies on pay-for-performance and the potential effects of this type of reimbursement on the doctor-patient relationship. I also interview Dr. Laura Petersen, chief of the section on health services research at Baylor College of Medicine and learn about her exciting ongoing research that may help us understand some of the issues involved.

If you have thoughts about pay-for-performance and its effects on the doctor-patient relationship, please leave your comments below or on Tara Parker-Pope's "Well" blog.

Doctor and Patient: Lessons from the Bedside Exam

It's rare to find a novel that draws you in from the very first page and re-inspires you as a physician. Cutting for Stone by Abraham Verghese, MD, is one of them.

In this week's "Doctor and Patient" column, I write about this terrific novel and interview Dr. Verghese. Over the last year, he has been an outspoken advocate of "bedside skills" and the physical exam in modern clinical practice. Cutting for Stone is perhaps his most effective and eloquent argument yet.

How important is the physical exam to you? Please leave your comments either below or on Tara Parker-Pope's "Well" blog.

When Doctors and Nurses Can't Do the Right Thing

Last month, a physician who is a member of her hospital's ethics committee told me about the increasing moral distress she sees in colleagues. Doctors, nurses, and other health care professionals "feel trapped," caught between their obligations to patients and the demands of administrators, insurance companies, patient families, and even each other. Many feel they cannot do what is right for their patients.

In this week's "Doctor and Patient" column,  I write about moral distress. Please leave your thoughts here or at Tara Parker-Pope's "Well" blog.