Who's changed: Doctors or patients?

I've lost a great quote from the novelist Saul Bellow which observes that in modern times we do everything in haste and no longer approach a person with a sense of sacred mystery. What does this have to do with health care? Much in many ways. For instance, the doctor-patient relationship- while still more intimate than other professional/client relationships- has become more impersonal, more routinized and less trusting over the last generation.

Many independent trends contribute to the present crisis in health care. But forcing those to whom we entrust life and limb to be chronically looking over their shoulders for fear of lawsuits and, then, compelling them to pay for ever increasing amounts of insurance is a prescription for weaker relationships.

Thomas Sowell after talking with his doctor who is hanging it up, "We can burden doctors with red-tape hassles, but we can’t make doctors put up with them." He illustrates how money and medicine interface in ways that are fundamentally moral and personal as much as scientific and technical. In the second half of my life I don't think I've ever discussed these matters with a doctor who didn't regard skyrocketing insurance premiums as a serious threat to the practice of good medicine. The fact that this concern arises from men and women of different specializations, faiths, politics and temperaments persuades me that this problem is real. It erodes their satisfaction in their calling and pressures them to adopt a manner that diminishes rather than builds a patient's trust.