While there may be value in a doctor-patient relationship, the current medical system makes such relationships very diffucult. When I developed a complicated condition, one that took years to diagnose, my PCP never had the time to see me during periods of acute illness. He never saw me when I was sick and all those important bits of information were lost. I suffered for quite some time before finding a specialist that was willing to care for me when things were bad, not just when I fit into the schedule.

In primary care, the doctor-patient relationship isn’t profitable.

I know this isn’t a discussion on health care reform but since someone is recommending a course of action you should make sure it’s at least going to possible in the future.

In all honesty, I see little difference between a hospital having in-house doctors and nurses or even hospital executives (of the three, only the doctors generate income). And I think that what hospital doctors make shouldn’t always be about what the doctor can bill, but what he/she does to keep the medical machine moving and stable.

The hospitalist “profession” exists now, in large part, because primary care providers were taken-for-granted and abused for years . . . by hospital administrators – who regarded them as “a dime a dozen” and treated them accordingly (even as they jacked their own salaries up) . . . by hospital/OR-based doctors (in Pediatrics that mean the OB’s and their pseudo-emergency C-Sections at all hours of the day and night – or ED doctors that were “uncomfortable” with children and turfed the entire work-up to the Ped) . . . and by patients themselves – who over the years honed their sense of entitlement, and the notion that “on-call” for emergencies means “beck-and-call”.

And let’s not leave out the lawyers – who hover like vultures over all of it – looking for the smallest mistake.

As things are done now, doctors (in whatever cog on the wheel) can set boundaries and limits. They can protect themselves and their private lives. It may or may not last.

Call me cynical, but right now, in medicine, people pretty much have what they asked for and deserve.

No one was really paying attention as it just happened.

The problem is relationship doesn’t mean much outside of context of the chronically ill. Relationship is why medicine is fun for me, but it certainly doesn’t count for much to malpractice attorneys, medicare payers and auditors, and angry family members who look often consider you third-string next to the specialists. Just go to CNN and read the posts from angry family members who have an ax to grind with their PCP whose relationship with their now sick parent seemingly counts for nothing.

“The Moving Finger writes; and, having writ,
Moves on: nor all your Piety nor Wit
Shall lure it back to cancel half a Line,
Nor all your Tears wash out a Word of it…”
Omar Khayyam, “The Rubaiyat”

Back to the office. Daughter Sally calls asking about her hospitalized Mom. She just got in from Osh Gosh and she is really worried about her mother.. You don’t have the information and will need to put her on hold. You hope the appraisal from the hospitalist meets your standards and you will not have to call back again. Without a doubt the patient-doctor chain has been broken.

As for better lifestyle arguments, if you get enough of these kind of phone calls it could put a damper on your day, especially with ramifications. Also adding more personnel to take care of the patient has just increased the cost. Hospitalists have overhead too. Your income will fall eventually because insurance will not pay the full freight for both.

For 30 years I was a solo physician making hospital rounds, house calls, and nursing home rounds. Yes sometimes it was a pain in the butt, but the gratefulness and professional pride I felt could not be substituted. Yes, I ate breakfast with my family, attended the kid’s functions, and went out on dates with my wife. The income for most of time was pretty good too. Choices, choices. If we make them and they are mostly correct, there will be precious little discussions like this one. To be more clear, picture yourself as the patient, and hearing the words as you are scared silly in a hospital, that Dr. X will be caring for you, instead of your family doctor with whom you invested so much trust. Remember some day you may have to be cared for under such a system and pay for it also.