Whatever Happened to Courtesy?

The changes in medicine predict the death of private practice. More than half of physicians in this country are employed by a larger entity—hospital, community clinic, university, insurance company. Personalized health care is being proctored by mammoth, faceless institutions. The doctor-patient relationship is intersected by the employer’s priorities, which, of necessity, must include economic considerations. “Efficient” medical care means less expensive care. As medicine mutates into a business complex, personal courtesy may be sacrificed.

In years past, reduced or waived fees were often extended to clergy, policemen, firefighters, other physicians, and their families. This bygone tradition was termed professional courtesy. Such benefits are virtually outlawed by Medicare and other agencies, which insist on maintaining consistent billing practices. Changing reimbursement patterns and organizational oversight also inhibit the practice. But it is also the non-professional courtesy which is diminishing.

The secretary you knew as long as you knew your doctor may be replaced by a new receptionist, hired by the institution, who may be frequently replaced. Or, your call may be answered by a computerized recording, insisting you push various buttons before communicating with a sentient entity. The doctor “on-call,” whom you don’t know, may respond to your after-hours phone call. The hospitalist, whom you don’t know, may be the physician who commands your inpatient care. Patients must be seen quickly and “efficiently.” There is little time for personal, informal conversation after the exam.

Treatment begins with medical brews and surgical pruning. But healing involves the personal ministrations between the doctor and the patient. We must be vigilant to insure that this relationship remains trusting, confidential, and, well, courteous.