Doctor–Patient Relationship: how it went off course and how to repair it

And suddenly, the body becomes the subject: the leg you walked on without noticing now hurts; the breathing you never watched grows shallow, the chest tightens, time narrows, and each inhale becomes work. The air doesn’t reach. A mix of alarm and doubt surfaces—anxiety, infection, heart?—and ordinary life pauses: everything is breathing. What do you do? You go to the doctor.

Why the doctor and not, say, the mechanic? Because they know how your body works and can guide you and intervene to make it work well again: they understand the mechanisms and the probable causal conditions of what’s happening to you; that’s why you go. You don’t go to this professional to fix your car or manage your finances, but to restore your health.

Why do they receive you? Because they trained for this: years in which the body stopped being textbook diagrams and became a scene—the temperature of a forehead, the rhythm of a breath, the color of fingernails; days and nights on call, learning to listen to what is said and what is left unsaid, to palpate and to auscultate; to tolerate not knowing and still decide with prudence; to tell signal from noise; to move from protocol to person; to err, repair, and hone judgment until patterns are recognized without losing the singular case. And why did they do it? Because they chose to place themselves at your service: to care for you and help you care for yourself.

Thus, when you go to the doctor a relationship is formed—what we call a clinical relationship—aimed at understanding, diagnosing, accompanying, and intervening to restore your well-being, or even enhance it. If that does not happen—if it isn’t oriented to caring for you—the relationship is emptied of meaning.

What went wrong

Today the clinical relationship has gone off course, leaving patients and doctors estranged in equal measure: you arrive, you wait, they call your name, they barely look at you; you speak in a hurry, you’re interrupted, your story comes out in fragments. You feel like a body on a conveyor belt: form, blood pressure, next. There’s more typing than eye contact—and no explanations.

And the doctor, for her part, finds herself making decisions she doesn’t agree with: if the coded “chief complaint” is “chest pain,” that itchy foot gets pushed to a “separate visit”; she orders tests that won’t change management of the illness because “the protocol requires them”; she can tell you want to talk and be heard, she wants to go deeper, but she has only twenty minutes and too many forms to complete. You leave feeling no one really cared; she leaves feeling she didn’t do what she was trained to do. It isn’t your fault or hers: it’s the result of a way of organizing the system that substitutes something else for care and interrupts what matters—understanding you, deciding with you what to do next to heal, and accompanying you.

What distorted that relationship? A notion of financial efficiency that turned from means into end. The issue isn’t that medicine is a business—we are one, too—but making revenue growth its reason for being. When profit sits at the center, the clinical encounter is reorganized like a production line: more volume, more billable acts, more referrals; less time, less listening, less continuity. For us, what should govern is clinical efficiency: deciding earlier, better, and with less harm—whatever actually helps your well-being.

How does a system like that grow? By increasing volume. Hence a doctor can see 2,000 patients a year on twenty-minute visits. And because surgery is the most profitable line, a bias toward surgery appears: it addresses advanced stages and emergencies—and when indicated, it saves lives—but it leaves little incentive (time, payment, recognition) to investigate the conditions that originate and sustain illness (habits, environment, work, stress, relationships). Result: what cuts and bills is rewarded; what prevents and understands is postponed.

Two key actors reinforce this logic: insurers and pharmaceutical companies. Insurers administer payments. The system is funded by citizens and policyholders and, seeing clinics push to bill more—and being growth-driven businesses themselves—they’ve built heavy layers of authorization and control. Pharma has developed technologies essential to clinical work, no doubt; yet under the same growth logic, it has promoted a pharmacological, drug-dependent culture that presents the pill as the answer to everything, reinforcing the bias against probing the conditions that originate and sustain illness.

And to be clear: it’s not that finance doesn’t matter; it’s that financial criteria are secondary to clinical criteria. The end is to restore your health, and that requires resources organized to make care viable—not the other way around. When the order flips, the purpose of the relationship—and its very form—gets distorted.

Now, we do think insurance should exist, but within a limited scope: to cover treatments, medications, and surgeries—not your day-to-day relationship with your doctor. When insurers pay for that relationship, their incentives inevitably bend it away from its purpose.

How it’s repaired

This is what Direct Primary Care is for: your family pays for the relationship with a fixed monthly or annual fee. By separating money from the visit, we remove volume pressure and fee-for-service incentives, so your doctor can give you direct access, time, and continuity—and make the sustainability of care depend on you actually getting better. In practice, that means a single direct channel to reach us; unhurried appointments; the same clinician (or small team) who knows your story; first-line resolution in primary care; and coordination—plus help interpreting specialist advice—when a specialist is needed. Clinical efficiency, not volume efficiency: decide earlier, better, with less harm.

What changes for you is not a slogan but the shape of the encounter. A symptom at 7 a.m. is not a bureaucratic obstacle course; it’s a brief exchange to rule out red flags and choose the next right step. A twenty-minute slot no longer forces your story into fragments; we can follow the thread—chest pain and, yes, that “unrelated” foot itch—because judgment needs context. Prevention stops being an abstract lecture and becomes part of the same relationship: sleep, movement, food, stress, work, and ties—addressed when they matter, not as a checklist.

For you, it’s straightforward: it restores the bond you’re looking for—direct, supportive, conversational, and built on trust over time. You are not billed for talking or thinking; you are not rushed into the next box. And when something exceeds primary care, we don’t disappear—we help you navigate what comes next.

That’s why ON Care is, first and foremost, Direct Primary Care.

Postscript. The Direct Primary Care model isn’t free of criticism or objections; we’re aware of them. To keep this piece concise, we’ll address them with full candor in a future post.