There was a time when the humble physician traveled to the homes of his patients, tendering care at poorly-lit bedsides with the help of a stethoscope, a reassuring pat on the back, and whatever medications could be fit into a small black bag.  

Payment was either cash or barter — and sometimes services were provided for free. 

As the doctor packed his tools and left the house, maybe already a few ticks past midnight, few would question the nature of the man who walked through the door.  

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His good-hearted intentions, and that of the profession, were abundantly clear.

Now years later, medical science has advanced far beyond the limitations of these relative “dark ages” of medical practice.  But although people live longer, healthier lives — thanks to how successfully disease is being battled on every front — the close doctor-patient relationship of the past has fractured. 

Physicians no longer are assumed to act from the position that they are their brother’s keeper.  Instead, suspicion and anger have become empathy’s uncomfortable bedfellows.

So what has changed? 

No one doubts what drives the heart of a doe-eyed medical student, cautiously peering into the room of her first hospital patient. This bright, kind soul has emptied his or her bank account and devoted countless hours to master the knowledge needed to be able to heal. Student and frail, emaciated, cancer-riddled patient  understand that they are comrades who struggle and suffer together.

But when a physician advances into practice, a metamorphosis occurs. Barriers begin to create an opacification of intent. 

Traveling to the physician’s office creates a geographic barrier. Medicare and the complexity of modern insurance, which requires patients to disclose payment information even before an appointment is made, cause an economic barrier. And a physical barrier comes between doctor and patient as we hide behind our electronic medical records and use technology in place of touch.

We have allowed empathy to become institutionalized — and we must now suffer the consequences.

Yet I still believe our intentions are pure.