The relationship between physicians and their patients is often thought of as sacred by healthcare professionals.
But as healthcare costs continue to climb and access to physicians plummets, some physicians have observed a shift from what was once a relationship based in compassion and care to something more transactional.
“The sacrosanct doctor-patient relationship has been morphed and changed and bastardized over time to be transactional,” Susan Baumgaertel, MD, an internal medicine physician in Seattle, told Becker’s. Dr. Baumgaertel practiced at The Polyclinic in Seattle for 25 years, where she also had an ownership stake, before launching her independent telemedicine practice, myMDadvocate.
The pressures squeezing trust
She said that the diminishing transparency over declining reimbursement rates and the destination of patient co-pays often lead to friction during billing. This, in addition to long wait times, claims denials and other barriers to care, have thinned the trust between physicians and patients.
“Most people are annoyed and irritated by the now-transactional nature. … [T]hat bleeds [together] and they can’t separate it out,” Dr. Baumgaertel said. “If they feel like they’re being gouged by by their insurance company because of pricing, the cost of medicine, care or [if] things are being denied, et cetera … the average person, the consumer, is not able to tease that out, because they lump the physician into that equation.”
This results in animosity often being shifted toward physicians, some of whom may be entirely removed from billing and other administrative processes at their practice.
“That is the foundation upon which all these other kinds of wrongs get piled up on,” Dr. Baumgaertel added.
As trust falters, violence may grow
Some evidence suggests an air of animosity has developed between patients and healthcare providers.
“In 2024, one of the biggest obstacles was and is the unchecked violence being increasingly seen in our hospitals, clinics, emergency departments and other workplaces nationwide. Healthcare is now noted as America’s most dangerous profession due to workplace violence,” Harry Severance, MD, adjunct assistant professor at Durham, N.C.-based Duke University School of Medicine, told Becker’s.
“This increasing violence toward doctors — and other healthcare workers — is one signal of deep critical disruptions within and consumer dissatisfaction with our current system,” he added.
In 2018, healthcare workers comprised 73% of all nonfatal workplace injuries due to violence, according to the Bureau of Labor Statistics. And, according to a 2024 poll by the American College of Emergency Physicians, 91% of emergency physicians reported that either they or a colleague were the victim of violence in the last year.
Addressing patient needs
Dr. Severance attributes this rise in healthcare violence to severe dissatisfaction in healthcare among patients.
“It is, in some ways understandable, that consumers, increasingly frustrated by a seemingly impenetrable, increasingly unaffordable and perceptibly denial-inclined system will strike out at one of the few accessible targets. In clinical situations, this will be doctors, nurses and other hands-on healthcare workers,” he said.
Dr. Baumgaertel noted that increased economic pressures and heightened political tensions over the last several years, in addition to healthcare-specific factors, could also be exacerbating this dynamic — something she has observed change with time.
“That is part and parcel of why it’s so fatiguing to try to deal with this,” she said. “Because public perception has shifted over time. When I went into medicine, hung up my shingle in 1996, people respected me.”
A pathway toward trust?
Egos aside, she continued, “there was value in that relationship. The patient trusted their physician. They knew that their physician was acting on their behalf and was doing their absolute best, or beyond their best, to care for them in every way. And then incrementally, over time, all those, you know, things that kind of put up barriers came into place.”
A desire for more transparency, autonomy and, ultimately, a reclamation of the physician-patient relationship, is part of what drives Dr. Baumgaertel’s current practice. She practices entirely through telehealth and bills for her time outside of insurance — likening her model to that of a lawyer billing for hours — and gets to focus more on the time she spends with patients.
“I think it behooves us — because no one’s going to do it for us — to kind of separate ourselves out from that and say, ‘This is how we’re actually caring for you, giving you value and using our clinical skills to go way beyond,'” she said. “Time will tell if these types of models are sustainable, because, again, the whole economy is not doing so well.”
