Sisyphus or Pegasus? The Physician Interviewer in the Era of Corporatization of Care

With the increasing corporatization of medicine, are physicians becoming Sisyphean drudges toiling futilely, forced to roll the stone uphill faster and faster, losing patients, pride in quality care, autonomy, and their own health? This increasing prevalent self-image—correlated with high rates of burnout and fundamental dissatisfaction with the profession—contrasts with the happier, Pegasus-like myth of the physician soaring on the wings of science and professionalism, experiencing the joys of effectiveness, altruism, moral probity, and wealth that attracted so many of us to medicine. Implicit in much Sisyphean negativism is victimization—by the nature of things, in Camus' existentialist version, and by the medical-industrial complex, in others. The extent to which we have perpetuated our own victimization and the extent to which it is remediable through our own actions are empiric questions.

Kaplan and colleagues [1] add a substantial brick to the edifice of potential self-remediation by showing the importance of physician-initiated participatory decision making in general medical settings. As part of the much-celebrated Medical Outcomes Study (which has been recognized with the Glaser award of the Society of General Internal Medicine and the Pew Primary Care Award, among others), Kaplan and colleagues asked three questions: “If there were a choice between treatments, would this physician ask you to help make the decision? How often does this physician make an effort to give you some control over your treatment? How often does this physician ask you to take some of the responsibility for your treatment?” They found that physicians who scored lowest (in the bottom quartile) according to their patient's ratings (with myriad correct and confusing corrections and controls) lost one third of their patients during the study period; the physicians most likely to encourage patients to participate in …