Impersonal care and poor rapport, that’s what! These are two very important aspects of medical care, today, that affect how physicians are perceived by their patients. The image of physicians portrayed in the movies and television has changed from “Doc,” the beloved town physician in “Gunsmoke” who seemed to spend more time in Kitty’s bar than his office, but knew everybody in town, to “House,” the most belligerent, arrogant physician ever minted.
For decades, the family physician was looked at as “competent, moral, and altruistic.” He was the “good guy” in town, loved by everyone, and available at any time, day or night. There were ER’s but physician staffing was limited to guys transitioning to retirement so your doc saw you regardless of the time or problem. Your family doc was the busiest person you knew. He was professional, wise, and the man whose opinion everyone wanted to hear.
After the Medicare Act was passed in 1965, the government and insurance companies exponentially increased the complexity of medical practice and began intruding into the business of medicine, physician attitude and demeanor took a downward trend. Doctors saw autonomy disappear and began shifting away from private practice. Running the business of medicine became more and more difficult. More staff was needed; staff you couldn’t afford because of lower and lower reimbursement for care. Doctors left practice or scrambled to find another way to stay in business. Employed physicians became the majority, and patient-physician rapport and the “personal touch” took a hit.
The pride and satisfaction of private practice were replaced by an uncaring attitude and poor customer/patient service. Then came the proliferation of NP’s and PA’s to further erode physician prestige. A quote from my reference article says “prestige used to mean status, autonomy, and deference. Now it means balance, sustainability, and preservation!” It goes from what was a revered practice environment to a small business just trying to make ends meet. The “covenant” between doctor and patient built on trust is losing traction, but patients will keep it going because they want a relationship with their doctor and want to be able to seek his counsel.
Young physicians don’t have the attitude of staying until the last patient calls. At 5:00 pm it’s time to go home. After hours, patients go to the ER. The family doc doesn’t have his sleep interrupted any longer. He doesn’t have to leave the office to tend to an ICU patient. There are designated doctors for those tasks. All of these issues are ways rapport, respect, and prestige are advanced. Trust is the foundation of the doctor-patient relationship, and it is the basis for the opinion the American public has of their physicians. Physicians desperately need to remember that and behave in a manner that reestablishes that bond.
Reference: Goto A. What happened to the prestige of being a doctor? Medscape 2026 February 5.
