Volume 72 Number 2 March 2005	back to contents

Professor of Medicine, Director, Center for Medical Ethics, Albany Medical College , Albany , NY.

Address all correspondence to John A. Balint, M.D., Center for Medical Ethics, Mail Code 153, Albany Medical Center, 47 New Scotland Avenue, Albany, NY 12208; e-mail: balintj@mail.amc.edu

Adapted from an Arthur W. Ludwig Lecture to the Department of Medicine, Mount Sinai School of Medicine, New York, NY on March 23, 2004, and updated as of October 2004.

ABSTRACT

Background: The health care system in the United States is in trouble. Patients and physicians are becoming increasingly unhappy with the system. There has been a progressive deterioration in trust in the system and in patient-doctor interactions.

Methods and Results: The history of the evolution of medicine as a profession over the past 350 years is briefly reviewed. The forces that have changed a paternalistic, but caring, system into one that is no longer paternalistic, but also less caring, are discussed. It is suggested that the current market-driven, industrial model is failing both patients and physicians, and that it is too costly.

Conclusion: The case is presented for patients and physician to join forces to work for reforms of the system, to encourage more physicians to take up careers in primary care, to fund health insurance for the uninsured, and to subsidize the education of future physicians. These approaches should help restore trust and a caring partnership between patients and their physicians. This partnership is necessary for attaining the reforms suggested.

KEYWORDS

Patient-physician relationship, health care system, health care reform.

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