Title: The Decline of the Doctor-Patient Relationship in the American Healthcare System
The American healthcare system, although among the highest in the world in terms of medical care expenditure per capita, still struggles with inadequate healthcare results. Soaring costs have made healthcare more unaffordable, hindering access to vital services. At the same time, the system is plagued by bureaucratic inefficiency that impacts patient care negatively. As a retired urologist with over twenty years of observational experience, I have seen these flaws both professionally and personally through family interactions. These experiences, combined with my advocacy for physician burnout and suicide prevention, have given me a thorough understanding of the current state of the system, notably emphasizing the concerning decline of the doctor-patient relationship.
The foundation of effective medical care, the doctor-patient relationship, is under threat. What was once a vibrant and cooperative partnership where clinical decisions were made collectively, has now been replaced by an environment where patients and physicians are overshadowed by external decision-makers. In the past, consultations about treatment options and their associated risks and benefits were crucial for informed choices in the examination room. However, this once-esteemed rapport is swiftly disintegrating.
Reflecting on the past, the decline began gradually, likely 30 to 40 years ago. When I practiced urology in 2000, most healthcare choices were made through direct collaboration with the patient. Fast forward to 2025, and these choices are frequently made with little input from physicians. For example, during my practice, the advent of physician assistants and preoperative assessment processes appeared to enhance efficiency but ultimately compromised my thorough comprehension of patient medical backgrounds. These changes, along with adherence to drug protocols, have further eroded physician independence.
The responsibility for this decline is shared. The medical community, myself included, unintentionally contributed to this transition, prioritizing efficiency and convenience over our role in decision-making. Clinical choices are now largely shaped by non-clinicians, committees, governmental bodies, and large healthcare institutions, creating a gap between physicians and their patients.
To restore the doctor-patient relationship, dedicated efforts are necessary. Physicians must regain their positions as primary clinical decision-makers, challenging the prevailing dynamics where external decision-makers hold influence. Doctors should be ready to face opposition, as those currently in charge often consider themselves superior decision-makers, overlooking physician expertise, and believing they are entitled to this role without the requisite training.
While I endeavor to remain optimistic about the future of American medicine, I am apprehensive. To restore the integrity of healthcare in our country, physicians must proactively re-establish the doctor-patient relationship, recognizing it as crucial to recovering the effectiveness and humanity of our healthcare system.
William Lynes is a urologist and author of “A Surgeon’s Knot.”