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Bill, thanks again for sharing your perspective. I am thankful that most of the medical doctors throughout my life (in several states in the USA, UK and Canada) have been competent and caring, which includes a gentle touch, explantations and time. Five years ago my doctors had to type in all the notes so it often felt as though they weren't looking at me. Now a scribe or a nurse is in the room so the doctor can give her/ his ful attention, which I greatly appreciate.

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It's good your atrial fibrillation is under better control!

Don't we all want trustworthy and caring clinicians? But the devil's in the details. There seems to be a push to redefine trustworthiness to mean an expectation that the clinician will carry out the patient's will (without any regard to health, per se). When some talk about a trustworthy clinician, they mean someone who can reliably use their technical expertise to do what I want them to do. Insofar as they contradict me, they're not trustworthy. Perhaps they shouldn't even be a clinician.

I worry this is fallout from applying machine-like standards to human care.

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