Humanism vs. Authoritarianism: What Happened to the Doctor-Patient Relationship?
Part 4 of the series: The Five Most Important Conversations in Healthcare
There was a time when the physical exam was the cornerstone of medicine. A physician would take your history, observe you, touch you, engage all their senses in understanding your body’s communication. The relationship built through this engagement was not incidental to care — it was care. The therapeutic value of being truly seen by a skilled healer has been documented since Hippocrates.
That relationship has been systematically replaced by the Medical Encounter.
The Rise and Fall of the Doctor-Demi-God
Medical historian Dr. Jan Henderson (Harvard and Yale trained) traces the roots of this shift to the first division between physicians and surgeons in the medieval period. Physicians stopped practicing hands-on physical examination. Scholarship was valued over sensory experience. Reason took precedence over observation. The educated physician valued mental activity and disdained manual labor.
By the 19th century, physicians were gaining social standing as science emerged. By the mid-20th century — the “Golden Age” of medicine — rapid advances in pharmacology and imaging had turned medicine into biochemistry and radiology. As Stanford professor Abraham Verghese famously noted: “I sometimes joke that if you come to our hospital missing a finger, no one will believe you until we get a CAT scan, an MRI and an orthopedic consult… We just don’t trust our senses.”
A 1997 JAMA study examined stethoscope skills among 453 practicing physicians and 88 medical students. Regardless of age or experience, the doctors correctly identified only 20% of heart problems.
The Lexicon Tells the Story
Language reveals assumptions. Notice what happened to the words:
- Doctor → Provider
- Patient → Client, Consumer
- Visit → Medical Encounter
Henderson identifies this directly: the Doctor-Patient Relationship gave way to the Medical Encounter. Both the physical exam and attentive listening to the patient’s history had provided psychological benefits that were at the core of the healing relationship. As both disappeared, those benefits were lost — correlating with a rise in malpractice suits and a dramatic increase in out-of-pocket spending on alternative health providers who still showed up with their hands.
Who Pays for Your Care — and Why It Matters
The history of health insurance in the United States is the history of competing interests reshaping the doctor-patient relationship from the outside. A brief timeline:
- 1798 — First record of health insurance: Congress takes wages from sailors to establish the US Marine Hospital Service
- 1929 — Hospital associations form Blue Cross; non-profit status granted (tax-free, free from insurance regulations)
- 1940–49 — For-profit insurance begins; can charge different rates for different patients
- 1950 — AMA succeeds in getting most states to ban pre-paid plans in favor of fee-for-service
- 1950 — Health care spending is 4.5% of GNP
- 1983 — Reagan passes capitation; Medicaid shifts to pre-paid amount per person per diagnosis
- 2002 — National healthcare spending reaches $5,267 per person — $1,821 more than Switzerland, the next highest
- 2005 — Health care spending is 16% of GDP
By 2002, health care spending as a percentage of GDP had quadrupled since 1950. We pay more per person than any other country on earth and rank well below comparable nations in outcomes. The disconnect between spending and results is not a mystery — it is the predictable output of a system that replaced the doctor-patient relationship with a billing code.
What You Can Do: Opting In to a Better Relationship
You have more choices than the dominant system wants you to know. Questions that help you find providers who still practice medicine as a relationship:
- How long is the average appointment? What happens if I need more time?
- How long does it take to get an appointment when I need one?
- Does the provider do a physical exam? Do they touch you?
- Do they listen to your history or fill out a form?
- Do they explain what they’re doing and why?
The RAND Patient Satisfaction Questionnaire identifies what patients actually value: time spent with the provider, explanation of what was done, thoroughness and carefulness, and personal manner (courtesy, respect, sensitivity, friendliness). None of these require a technology upgrade. They require a human being who shows up for the relationship.
The practitioner who brings both clinical excellence and genuine human presence into the room is the practitioner people come back to, refer their families to, and trust with the most important moments of their lives.
Dr. John Edwards DC, DACCP is the founder of One Belly Two Brains, a perinatal chiropractic mastery program. This post is adapted from the “5 Conversations in Healthcare” public education series.