An old maxim of general practice says that doctors get the patients they deserve, because patients actively seek out like-minded doctors who share their own health beliefs. The health-anxious seek health-anxious doctors; both value so called thoroughness, and referral, and refuse to accept any uncertainty. Likewise, some doctors and patients are bound together by a degree of fatalism. Both are happy to accept risk; happy not to treat, refer, or investigate. What passes as denial to some seems like only common sense to others. Once upon a time doctors understood that medicine was more opinion than science, so were tolerant, supportive, and respectful of differing perspectives. But this balance in the doctor-patient relationship is under threat, with any, even realistic, fatalism increasingly deemed unacceptable.⇑
Despite modern medicine’s supposed so called patient centredness, the medical model (that all symptoms have a pathological cause, to investigate, treat, and cure) is absolutely still the prevailing mindset within medicine. This is despite most contact with patients being driven by abnormal health seeking behaviours, cultural aspects of care, or medically unexplained symptoms—facts lost to the educators. And the medical model is ever more powerful; opinion is usurped by the perceived infallibility of so called evidence. Despite the glaring weaknesses and naked commercial interests found within much research, “you can’t go against the evidence.” The rise of the superspecialist means absolutism is now the norm not the exception. The paradox is that medicine is supposedly more enlightened, but it has never been more tyrannical, hierarchical, controlled, intolerant, and dogmatic. Working doctors who dissent are cowed because failure to comply with the medical orthodoxy threatens livelihood and registration. Much of modern medicine is an intellectual void.
The current situation is far worse for medically sceptical patients, who are denied the opportunity to consult doctors who share their health beliefs. Changes in working patterns mean continuity is broken and doctors are less available and less experienced. Doctors’ consultations have been reduced to some universal unit of medical time, not a long term relationship of the like-minded. In every consultation, onscreen pop-ups prompt us to record blood pressure, weight, screening, and the rest. Payments provide incentive for this intrusion, making refusal difficult. Everyone is made into a patient; there is no opt-out clause, no choice. Patients complain that they are “pushed onto pills”; captive to constant computer generated recall, yet no one listens. Medicine shows no respect for any fatalism, openly scolding patients if they have different health beliefs. This is all set to get worse, more pervasive, more paternalistic, and less persuasive. Are patients really getting the doctors they deserve?