Don't physicians deserve a little pedestal?

It was depressing. I went into Discount Tires, some time ago, to get a slow puncture fixed, only to be told my tires were so bald I needed four new ones. But what was depressing wasn't the bill they were giving me but what I already had in my hand: A waiting room copy of U. S. News & World Report, with a special report on "How to be a smart patient."

There's obviously nothing wrong with having our patients' being better informed. Surely both sides of the stethoscope benefit when our patients understand their health care needs. But what the doctor-patient relationship doesn't need is the cynicism patients develop when they read this adversarial fluff in popular magazines.

At about the time U. S. News & World Report was encouraging its readers to challenge physicians even though "it's tough to go up against godlike powers, to confront someone viewed with reverence, who can exacerbate illness or offer cures. It's hard to take on the almighty" and so on, a Gallup Poll gave the public's opinion as to which professions or occupations had the most integrity. I recall nurses came in first at 79% followed by grade school teachers, pharmacists and military officers. Medical doctors came in at 67%. We were, however, ahead of car salespeople.

Think about that percentage for a moment. It means when our patients enter our offices they feel they have one chance in three that the doctor who attends to their problems will lack integrity!

Something is going very wrong.

OK. We can't wish for the old days, we surely don't want those old days when well-meaning, paternalistic, autocratic physicians gave patients, at best, little time for discussion or introspection and, at worst, the door if their opinions were challenged.

One of the best -- but grumpy -- country doctors I knew in Texas in the early 1960s would bristle if patients asked questions, though he tended just to ignore them if he was in a good mood. Those days are surely past.

But we did go to medical school and our patients didn't. And that should count for something though we must hide that particular hubris from today's patients. I do, however, remember treating a fussy, older woman in New Hampshire in the mid-1960s. She kept challenging my decisions with, "My aunt is 90 years old and really smart. She says you shouldn't be doing this and my aunt says you're wrong about that." I finally murmured, "And where did your aunt go to medical school?" She snapped back, "Woman's Medical College of Pennsylvania, 1895."

So, yes, we need to improve on the behavior of the old days. Strutting on our pedestal was clearly inappropriate but did we really need to have so much marble chipped off?

Information technology is part of our image problem, a valid part, and I've long thought a sophisticated, intelligent patient with, say, both a degree in engineering and a rare disease should have the skill and incentive to learn about it and end up knowing more about his rare disease today than I ever will.

Part of the problem is the cold-fish personality of some physicians in whom the milk of human kindness has long gone sour. And part of it is the medical school curriculum, so weak in developing empathy in the type A medical students that most schools attract because the students sense only type A's are going to survive the intense schooling.

And most of it is the failure of managed care to resolve the main issue: Health care in the United States is fragmented and financially and emotionally broken -- irreversibly.

And I have no idea how to fix it.

I have no doubt that compassionate, individual doctors who really care about their patients will prevail, but this unease, this malaise that affects or even infects the public represents a major change in how tomorrow's patients will seek and demand care from their physicians. Receptive to TV advertising, armed with print-outs from the Internet (some of it, much of it, nonsense), fueled by anecdotes from sometimes narcissistic friends who believe that every minor office visit dignifies elitist treatment, they will all behave as if their aunts graduated from Woman's Medical College of Pennsylvania.

And I may be too old to deal with this. All my aunts were farmers' daughters and farmers' wives.