Healing the profession

Physician works to restore doctors’ stature

Twenty years ago, Dr. Norman Jensen was ready to give up his internal medicine practice and teaching responsibilities at the Medical School.

Deeply frustrated and nearly burned out, he considered moving his family to their cabin near tiny Siren, Wis., and becoming the North Woods doctor he had first intended.

“I had been working for years, trying to teach medical students and residents about communications using traditional academic approaches like lectures and reading assignments,” he recalls. “But it wasn’t grabbing them. It seemed as if they didn’t care at all about the “people’ aspect of medicine. I was very discouraged. I was starting to believe that communication skills couldn’t be taught.”

Then Jensen heard about Balint groups, a concept Hungarian doctor Michael Balint created to help physicians work through difficult cases by discussing them with each other. Balint taught doctors some practical ways to deal with their patients.

Jensen thought he could use a version of the technique to get his residents interested in talking with each other — a starting point. With help from James Gustafson, a Medical School professor of psychiatry, he organized his own Balint groups — small discussions revolving around the most challenging patients, such as those with persistently unexplained symptoms.

“Holy mackerel, did I have an attitude conversion!” says Jensen. “I began hearing story upon story of pain and agony from these young doctors. As they opened up, I was amazed and I learned so much.”

Heartened and recharged, Jensen today is dedicated to restoring doctors’ stature and respectability in American society. “Medicine’s reputation is eroding, and I’m worried about it,” Jensen says.

Getting physicians in touch with each other and their patients, as he learned long ago, could be the key. Jensen, who now cares for patients at a UW Health general internal medicine clinic, is working with the State Medical Society of Wisconsin to articulate and address problems facing the medical profession.

Reclaiming forgotten aspects of professionalism and improving interpersonal communication are at the heart of the solution, he says. Jensen readily broaches this touchy topic, but not because he wants to discourage new students or anyone else. On the contrary, his love for the work leads him to believe it’s his professional duty and personal responsibility to restore medicine’s respectability.

Statistics show that doctors do much of their job well, earning the respect and appreciation of their patients in the process. But statistics also show a shuddering rise in malpractice suits, an alarming number of deaths resulting from medical errors and increasing reports of patient dissatisfaction with interactions with their physicians.

“The public thinks doctors don’t spend enough time with them or inform them adequately. They object to our attitude,” Jensen says. “Many, many people think doctors don’t listen or care about them.”

Jensen asserts that public dissatisfaction with medicine extends to the way physicians act in society. “Public opinion says doctors are greedy and that we are slow to own up to patient safety facts.” Furthermore, physicians are seen as weak leaders on critical social issues involving medicine.

Jensen suggests that doctors need to keep in mind their role in providing a public service to people who are often vulnerable. Professionals put the welfare of their clients or patients above their own, and are guided by high moral and ethical standards. Professionalism involves a commitment to excellence, as well as demonstrated honesty, altruism, empathy, respect, caring and compassion.

“We are in trouble because we’ve broken our professional covenant to abide by these requirements,” Jensen says. “We’ve broken our professional covenant in the community, the exam room and at the bedside.”

Last year, Jensen gave a talk to nearly 400 members of the State Medical Society that convinced its board of directors to create a task force that works within the Council on Ethics and Judicial Affairs. With Jensen as vice chair, the task force is working to support professionalism among physicians. For his part, Jensen recommends several steps to help physicians to restore their reputations:

“First, doctors have to be more visible in their communities. We have to sponsor good works and healthy activities on the local level,” he says. “Doctors of the past were always community leaders, but in recent years we’ve become isolated in our hospitals and clinics.”

Doctors must be more involved in state and national politics, he contends, by visibly supporting candidates who lobby for medical reforms. “It is our responsibility as professionals in our society to advocate for universal health insurance,” he states.

The profession should be strongly advocating for a fully resource-based pricing system that includes drug pricing, he adds. “When we show the public that we are willing to put our full leadership potential behind the achievement of a first-rate, affordable American health-care system for everyone, we will go a long way toward regaining the respect we have been missing.”

In addition, doctors must take the lead in making health care safe and effective. “One important way to do this is by guaranteeing that the best evidence for all medical practices is available to all doctors, not just at UW Hospital, but at hospitals and clinics across the state,” he says. “The simple act of slowing down will also reduce errors.”

Finally, doctors must enact professionalism with every patient, every day. In Jensen’s view, the most important way to do this is for doctors to improve the way they relate to their patients.

“Psychologist Dr. Carl Rogers, who was on the faculty of UW Medical School for several years, summed it up beautifully,” notes Jensen. “He said professionals involved in helping relationships must be real, must be empathetic and must be accepting. We must learn to perfect the art of human interaction.”

That can be especially hard in a profession that sees so much pain. Most doctors do care, but many adopt a silence that patients perceive as uncaring detachment. “They care so deeply, in fact, they can’t even speak it. But to become silent about patient suffering is to become dysfunctional as a doctor,” Jensen says. “I want to help them speak, and deal with their sensitivity in a healthy way.”

For three years, Jensen and many other faculty members have been helping Medical School students perfect the act of speaking and other facets of interpersonal communication in the Patient, Doctor and Society course. The required two-year course teaches, among other things, ways to develop a communication style, build rapport, listen intently, respond to patient emotions, and explore and respect different cultures.

“Patient-doctor relationships are human connections — ones that go both ways,” he says. “I think we’ve lost sight of much of that basic humanness. But as with all relationships, with desire, focus and practice, we can improve.”