December 22, 2011 - Lauren Vogel, a journalist from CMAJ, called yesterday to ask me about the rules in parts of Canada that allow doctors to insist that a chaperone accompany patients during an examination. She wanted to know if doctors should have that right and what we at the Patients’ Association thought about it. It seemed to me that this was yet another indication that the relationship between patients and doctors has been changing in ways that make it more and more difficult to provide continuity of care. That some people feel that we have to do this attests to a growing mistrust in the doctor-patient relationship.
Continuity in care becomes more important as the population ages and people begin to have chronic conditions that must be monitored over time. Our system however is structured around discontinuous episodic care that is more appropriate for acute conditions than chronic ones. The perceived need to have a chaperone accompany a patient suggests a worry about the interaction - one that might be averted in long-term continuous trusting relationships.
To some extent this measure and others like it are evidence of increased dissatisfaction among both doctors and patients about the nature of their interaction. There are many things about the system that serve to increase the discontinuous and episodic nature of their interactions. Doctors are overworked and very busy. They are paid by the episode of care rather than to provide ongoing care. There has been an increase in “instrumental†medicine that relies more on test results and less on getting to know and understand the individual patient. The result is a worry that both doctors and patients have about knowing and being known by each other.
The most expensive and ineffective way of dealing with chronic conditions is to treat them episodically, instrumentally and without the participation of the patient. Everyone knows this. Adding more measures that amplify mistrust is not the real answer. We must figure out how to do things differently.