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How did Something as Personal as Medicine become so Impersonal?

March 7, 2016

I first started practicing medicine in 1969 as a family practitioner. I by chance became one of those rare people whose mentor was the chief of pathology, urology and general surgery for most of his life in Bethesda Hospital in St. Paul, Minnesota.  Dr. Arthur Lundholm was at my side and taught me tirelessly in all of those specialties for five years. I guess you could call it the greatest multispecialty residency available. He also taught me how important it was to know your patient.

 

In the early years of my practice it would be a rare time when most of my partners could not say “Hi” to a person in the waiting room, call them by their first name and ask about other members in the family. This was also true of most other family practitioners I knew. This is immensely helpful in caring for patients. You know their history and what medications they are on. It is much harder to care for a stranger.

 

Have you ever wondered when you go to a clinic why you may end up with a different physician each time you go? Often the large multispecialty clinic does not really care who you see. One reason for this is that a physician who sees his same patient population all the time and befriends them, is also more likely to take that group of patients with him if he leaves practice in that clinic.

 

When HMO’s, PPO’s and large corporations inched their way into the practice of medicine seeing patients became a numbers game for them. The more patients a physician working for them sees, the more money they will make. Suddenly doctors had quotas. This means a family coming in to see you who lost their child yesterday is given about the same amount of time as someone who has poison ivy.

 

I think all of you realize this manner of rules and regulations by corporate America does not fit the picture of the kindly old family practitioner. Can this be changed? Maybe with time, but I doubt it. There is simply too much money to be made in medicine. The United States spends more on health care per capita than any other industrialized country in the world. We also are also one of the highest in the world on what percentage of our GDP goes to healthcare. 

 

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