Men asked whether, if impotence could accompany surgical treatment of benign prostatic hyperplasia, going under the knife was necessary, and many more physicians began to recommend watchful waiting. In managed care, respect has helped populations of patients, but has been less helpful to individuals. On one hand, pain relief and care near the end of life are near the top of the national ethics agenda. Rates for mastectomy, Caesarean section and transurethral resection of the prostate are down. Survival rates are stable.
Quality of life is up.
On the other hand, there is less time than ever for developing sound doctor-patient relationships. Physicians' practice patterns are being scrutinized for nonconformance. Patients will switch organizations and physicians for a few dollars a month, and those few dollars are the value of the relationship. Physicians also deserve respect and have had little from managed care plans, payers and employers. Too many doctors now feel disheartened and impotent.