Monday, June 4, 2012

Solo Doctors as Artifacts

     For many years my older patients (over 65) would regale me with stories about their childhood small town doctors.  These were transplants from Maine, Michigan, Pennsylvania... snowbirds who had relocated to Florida for warm weather and who missed many things about home.  In essence they were telling me they wanted me to be like their doctors of old.
     "When you went to the doctor, he did everything right there!"  "He knew you and your whole family all the way back!"  "He went to the same church, you saw him at the July 4th parade, he was a pillar of the community."  "He practiced his entire life, until he died at 88!"  "His work was his whole life.  He didn't think of retiring;  doctors didn't retire in those days!"  "There were no referrals here, there and yonder...he was it;  he had equipment and know-how.""If you were on your deathbed, you went home to die, and he would visit you there."  "Those were the days when doctors did house calls!" "Those were the days!"
     The image that comes to mind is the one in Norman Rockwell's painting, "Before the Shot," published on the cover of the Saturday Evening Post on March 15, 1950.  In it the doctor, wearing his white coat, surrounded by the appurtenances of medicine, is drawing up a shot for an anxious youngster who is perched on a chair holding up his trousers and examining the doctor's medical certificate on the wall.
     The doctor who served as a model for this painting was Dr. Donald E. Campbell.  The Washington Post printed an obituary about him when he died on May 16, 2001. "Dr. Campbell, 95, small-town doctor who made house calls for more than half a century...the only doctor in this small Western Massachusetts community for decades.  He did his own laboratory work and developed his own x-rays between examinations in his cluttered office on Main Street...and continued to make house calls until his 83rd birthday."
     Is this doctor an artifact?  Was there something wrong with this style of practice?  Why has the delivery of medicine changed so drastically?  Why is it practically impossible for doctors to practice like this any more?
     I ask these questions out of my own personal experience as a doctor for whom Dr. Campbell is still the model--but for whom, despite all my efforts, the possibility of practicing this way is being obliterated.  I am aggrieved.  So many circumstances have risen up like ramparts and war machines, against my naive belief that I could hang up a shingle and take care of patients in my own office in accordance with my medical school application assertion, 25 years ago: "I want to help people." It may have sounded trite back then but, after all, didn't we all write the same thing in our medical school applications, desperate to become doctors, truly wanting to help people and carry on the tradition of medicine that extends back to Hippocrates?
     Is it not the case that we all want that old-time doctor to survive?
     The new healthcare proposals call for a "patient-centered home." This is the family doctor, the one you stay with for life.  Even when you get sent to the hospital or are assigned to a multi-specialty HMO practice, don't you wish for that old-time doctor who delivered you, knows you, cares about you--the doctor whose personal investment in your well-being goes without saying?  That doctor's reputation is everything.  That doctor's creativity, compassion and intelligence make medical treatment unique.
     In the next few months I will outline why the doctor who cares and "does it all," is an impossible--and now persecutory--paradigm.  Despite my training and twenty years of experience, I want to resign.  I think solo physicians in the United States are all similarly frustrated--maybe even irreclaimable.  We are doctors who were groomed to be Dr. Campbell, a person who was--using my patients' moniker--"a real doctor."

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