The future of doctors? Airline pilots provide a clue.

When I was a boy, my dream was to become an airline pilot. The job seemed glamorous and exciting, and appeared to be held in high regard by all the people around me. I actually used to have a bit of an obsession with airplanes, and living so close to Heathrow Airport, had plenty of opportunities to see planes and visit the airport: both as a passenger and whenever we had family or friends to pick up.

Whenever we would fly anywhere, my dad would arrange for me to be shown into the cockpit (those were the innocent days pre-9/11) and I particularly remember the Pan Am pilots being very nice and inspiring, patiently answering my schoolboy questions like, “How do you take off?” That was back in the 1980s, still a glamorous time for flying (although my experiences were with international flights only). The air stewards and stewardesses also had what many thought was an enchanting job. To draw on a famous example, Kate Middleton’s mother, the future King of England’s grandmother, was a stewardess back in those exciting days. Those times when people would eagerly anticipate their journey and dress up in their best clothes to fly.

However, over the last couple of decades, the airline profession in general has become very different from what it was back in those glory days. Looking back now, I’m very glad I made the decision to become a doctor instead of a pilot. What changed and are there some lessons here for doctors and the health care profession in general?

First, the proliferation of flying means that it’s no longer the special experience it used to be. Make no mistake, this is probably a good thing on the whole for customers, but it has definitely contributed to flying being seen as more routine.

Second, the whole airline industry has become much more cookie-cutter. What do I mean by this? Well, it’s become very mechanical, protocol driven and automated. Again, a good thing in many ways, particularly for safety, but this has also come at cost. Here there are some real lessons for health care. A couple of decades ago, it was not unheard of for pilots to sometimes walk out of the cockpit and greet some passengers as the co-pilot took the reigns. They also seemed to talk to their passengers more during the flight, pointing out locations and things to look out for outside the window. They could even decide independently to take a small detour to give their passengers a “good view” of a particular site. I’ve heard of this happening on several occasions, over sights such as the Grand Canyon and other National Parks. Totally unthinkable now!

As for the air stewards and stewardesses, they often had more leeway in terms of what food they could serve you and appeared to have ample time to chat and answer questions from their passengers (remember, more questions about flying and destinations back in those days of fewer phones and no Internet). To draw a comparison with health care, when we make things cookie-cutter and automated, we also take away from an experience that many people view as very personal and special. The right balance has to be struck in a profession such as health care. Protocols are wonderful and mechanization can have its place, but this can’t come at the cost of our patients not feeling that they are getting personalized care in a compassionate and welcoming environment.

At a time when we pride ourselves on customer service and providing a better experience, isn’t it ironic that if you ask passengers who can remember far back enough — many of them will tell you that they didn’t feel a big difference in terms of service back in the old days (indeed many will tell you it was even better). I dare say the same is true for health care, when patients a few decades ago actually didn’t feel a lack of good care at all.

Third, and perhaps most profound, is the fact that passengers and the general public no longer look up to pilots in the way they used to. Why is this? Well, the job seems less than prestigious when you see them walking through most domestic airports. They line up in restaurants and coffee shops, often wait with us in the same lounge waiting area, and frequently catch the same shuttle back with us after we land. They may get to go through security faster, but that’s about it. The airline industry has allowed this to happen. Very real parallels here with health care, where as more and more physicians are directly employed by their organizations, the whole thing can take on a more “corporate” feel as the employees are turned into “workers.” I’m not saying that the employed model is necessarily a bad one, we just have to be careful if it takes away independence, autonomy and perks that a highly educated professional deserves.

Granted, being a pilot and being a doctor are two very different professions. There are many things that both can learn from each other, and I have the utmost respect for pilots who do a great job on a daily basis. Despite the challenges we face, I still think being a doctor has its glamour, appeal and admiration in today’s society. But as health care changes, we must do everything we can to protect our sacred and honorable profession. There may not be very long left.

Suneel Dhand is an internal medicine physician and author of Thomas Jefferson: Lessons from a Secret Buddha and High Percentage Wellness Steps: Natural, Proven, Everyday Steps to Improve Your Health & Well-being.  He blogs at his self-titled site, Suneel Dhand.

Comments are moderated before they are published. Please read the comment policy.

  • W. X. Wall

    You’ve made an excellent analogy, but I would go further: making air travel cheaper has resulted in two (3?) tiers of flying: first class and economy (the truly rich also have private planes). Economy class flying, while it has become cheaper, safer, and more widely available, has also become less personable, and overall is turning into a miserable service experience worse than greyhound bus service. But it gets you from point A to point B safely.

    First class is getting more expensive, more outlandish, with service topping the so-called glory days of the 70s/80s. Yes, it still gets you from point A to point B in the same exact time and same exact safety risk, but the experience is much more pleasant.

    My only hope for medicine is that as we move further along the road to multiple tiers, it’s only service levels that are cut, and not the actual quality of the medical care. At least in a flight, the first class and steerage folks are both in the same physical plane so rich or poor, everyone is concerned about the safety of the flight…
    (ironically, the truly rich, in private planes, have a worse safety record…)

    • DeceasedMD

      We’re already there with the deterioration of PC. Many more pts misdiagnosed and lost in the system.

      • Kristy Sokoloski

        I was without a Primary Care Physician for 7 years (2001-2008) and several of the doctors that I have caring for me I found during that time. Also, during that time without a Primary Care Physician I went without having an actual physical done by them. And when I finally did get back to having a Primary Care Physician (went back to the clinic I had been part of until I left in 2001) I still did not have my actual Primary Care Physician do an annual physical. That was until 2012. The reason? Because at the time my gyn (and this was before they were considered to be Primary Care providers by the insurance plan I have had since 2003) was doing all this for me. But she has slowly gotten away from doing that. Yes, all of this was going on when at the time I thought having an annual physical and well woman visit was of benefit to me. So over the years I have been able to coordinate my own care and I prefer it that way. But not everyone is like me so yes they definitely need a “Primary Care Physician”. So why do I bring this up? Because of what you said about many more patients being misdiagnosed and lost in the system. In my earlier years that I had an actual Primary Care Physician they missed a number of things when it comes to diagnosis. Two of them were some of the female issues I had. It took someone else that was not my Primary Care Physician to find the problems.

        I am wondering if in part the reason that Primary Care has deteriorated as it has is because many in the public don’t trust them anymore. I have heard it said over the years (although not as much now because some people don’t have very strong opinions about various specialties either) by others that they had felt like their specialists listened better to them than their Primary Care Physician. However, I am noticing that even in the specialty clinics they are not having as much time to spend with their patients as they once used to. This is especially the case for some specialties more than others. We were at a specialist’s office last week and that was the first time I ever noticed the feeling that I hear others talk about: that of like an assembly line. They were doing appointments every 10 minutes. And when we got to this office the waiting room was packed. Some people that were waiting had been there for over an hour. And it felt like it was much longer than that. I find all of this when it comes to the way others think about doctors whether Primary Care or specialist very interesting. Unfortunately, I do not mean that in a good way. And of course when I left that office I did not have a very good feeling and especially because not all of the questions that should have been asked did not get asked. And that in turn meant no answers to make me feel satisfied and like I could say “you know what, I have a good feeling about this doctor”. It’s been a long time since I walked out of an office where I didn’t have a good feeling about the doctor.

        • DeceasedMD

          i think you nailed it. Any system that treats people like cattle or puts them on an assembly line is doomed to fail. What can you really do in 10 minutes? Really does not matter how skilled a doc is. In essence Kristy what you have proved is that makes people lose trust in the doc.

          Unfortunately instead of rebeling to change the system, I am guessing many people just withdraw. I agree that is a horrible way to treat people. The airline industry is similar but at least they get you there safely. It’s a disgrace.

          • Patient Kit

            And since many Americans aren’t personally experiencing good primary care, it will only get more difficult to motivate them to want to save primary care. Some people remember good primary care, some hopefully still have it, others can imagine it. But more and more Americans have never had it. And it’s hard to get people to miss what they never had.

          • DeceasedMD

            So well said. That is so very true. And I think it even applies to all involved. Imagine how that affects the training of PCP’s. They will not know what they are missing and and never learned. The teaching and knowledge is also lost. As pts are in the system. very thoughtful analysis of the situation.

          • Kristy Sokoloski

            Very true.

          • Kristy Sokoloski

            You are correct that it is a disgrace. And it’s funny because of the fact that years ago I actually flew but never noticed an assembly line feel. I have not flown again since 1994 (yep, long before the events of 9/11) so I have no idea just how bad it is from that aspect but I did notice that because of the things that were put in place to try and further attempt to keep the public safe it would be more problematic. So it’s like that’s it my days of flying are done. I was mentioning to my relative about my observations at that specialty clinic that I mentioned to you. My relative was like “well, at the retina specialist they bring the people back to have the drops put in (those lovely drops that further dilate the eyes so that the doctor can see the back of the eye) and then they sit and wait for a bit before they see the doctor. Like I explained to her that was not the same thing. And with that clinic where the retina specialist was the wait times there was 3 hours so I learned to make sure that I brought a big book with me. It’s also interesting to note, at least from the news, that there are more problems with a certain federal agency that works closely with the Aviation industry if you will. And they said in a report I heard the other night that people are going to be charged a bit more for something that related to one of the tasks that this agency does. I thought that was pretty interesting. Again, not meant in a good way.

          • DeceasedMD

            I agree. Stay away from airports and MD offices.

          • Kristy Sokoloski

            I will definitely stay away from the airports. As for the M.D. offices, I am having to fire two of them but not for reasons like this. I just couldn’t believe what I saw at this one specialist. But yet at the clinic where my PCP is I haven’t ever seen that but yet that clinic like the one where I did my externship when I was in school for Medical Assisting back in 2011 is a mad house. And even in 2011 it was a madhouse. That was really something to see. If I could stay away from M.D. offices all together I would gladly do so. Unfortunately for me, that is not entirely possible yet. I hope to work on a way to make that possible.

          • DeceasedMD

            You sound like you are certainly having your share of problems with them. It is especially unsettling that you are noticing a deterioration since 2011-only 3 years ago.

          • Kristy Sokoloski

            You are correct about that it was unsettling to notice a deterioration in only just 3 years. And never thought I would ever see the day that I would see it at a specialist’s office because of the way some still think about specialists.

          • DeceasedMD

            Was the specialist office associated with a hospital? Was there a facility fee? Sounds like you found your self another MIC-Medical Industrial complex. But you are correct in your assessment as i see the same thing happening with specialists at any hospital are managed to some degree and what i think what is unsettling as well is that diagnosis will be missed with an assembly line unless you have a very bread and butter kind of illness.

  • QQQ

    I actually have a better experience taking the Greyhound bus than taking the airlines! Their 800 number service is excellent, my buses arrive/depart on time, the fares are very reasonable (with better discounts for me), my luggage doesn’t get damage or lost, the seats are spacious, and comfortable, and the staff at the stations are friendly and attentive. If your traveling a long distance and you need to get there in a rush, its better to take the plane! Otherwise I take the bus.

    I have to go to Washington D.C. this August and the fare round trip only cost me $28.50 from NYC and back!

    As for the airlines? Its the opposite from what I said! Specifically with American Airlines!

    Make medicine like the bus lines! (^_^)

  • Suzi Q 38

    On Dr. Wible’s blog there is a you tube film with a doctor having difficulty with his profession. He describes the human mistake. He said that they interviewed pilots who wanted to be warned if they were about to make a mistake, regardless of where or who the warning originated from.
    Compare and contrast this to the average surgeon, who according to this doctor, said that most surgeons did NOT want to be “called out” or warned about an impending mistake. they would rathe not be told and not know.
    He (the doctor in the interview) surmised it was because the pilot wanted the warning because if warned, h/she would not only avert a disaster for the passengers, but h/she himself/herself was also a passenger who would perish in the same crash.
    The surgeon is different. While many would say that they care, they could not care in the same manner, as they are not the ones living with a bad medical error or experiencing death as a result of the error.

    Their egos were bigger than the patient, who is the innocent one lying asleep on the operating table. Even though any medical professional should “call out” or “sound the alarm” even privately to that surgeon or doctor, no warning is forthcoming because it is NOT welcomed.

    The patient is none the wiser, because h/she is in a very vulnerable position either asleep or too trusting with their doctors.

    I will sound the alarm:

    Be your own best advocate for you and your family members.
    At the hint of any problem, good see the nurse navigator or patient advocate. If there is no action or concern, check around carefully for a new doctor and hospital that is more careful, more responsive and cares.
    Afterwards, quietly “ditch” the former doctor and hospital.

    Lastly: Warn others.

    • Karen Ronk

      An excellent analysis. As you say, pilots act in self interest because they can be killed or harmed due to their own error. Most doctors never pay for their mistakes. And that will not change unless we create a less adversarial system to deal with those mistakes. But as you point out, it is crucial to spread the word about bad doctors/surgeons.

  • John C. Key MD

    And in our next scene, the flight attendant will land the plane!

    • Kristy Sokoloski

      Yep, so true.

    • Patient Kit

      Forget flight attendants. Some in the industry envision nobody in the cockpit! They envision jets being flown remotely either by a “ground pilot” who will pilot multiple flights simultaneously from the ground. Or a computer will do that remote piloting from the ground. Think of jets as elevators. Who needs an elevator operator? It all makes me think of children flying remote control toy planes on the beach. They almost always crash. I’m just glad there was a great surgeon in the OR with me and the robot last year. I would not have been comfy with just the robot.

  • Patient Kit

    I flew out of NYC the same day that Capt Sullenberger successfully landed a US Airways flight in the Hudson River. I only found out what happened back home in NYC that day later that night in Mexico. Everyone survived that amazing emergency landing. It does matter who is in the cockpit.

  • DeceasedMD

    that’s pretty sad!

  • Eric W Thompson

    Quality costs. Most people do not want to pay. Being treated like cattle is the cheapest way to go. Few want to pay the true cost of their health care but demand the best and most expensive treatment. If the patient wants an hour with his provider instead of 10 minutes, someone has to pay for it. Whether the insurence company, the patient or the provider (by taking a hit in payment).

    • Patient Kit

      By saying that most people don’t want to pay, are you implying that most people have the ability to pay what healthcare costs in our system? They just don’t want to pay? I think there are plenty of people who just don’t have the money. We’re having to choose between healthcare and a roof over our head and food on our table. Not everyone is choosing new cars and expensive vacations over healthcare. Food and shelter.

      This year I received excellent treatment for ovarian cancer, paid for by Medicaid, funded in part by me paying heavy taxes for 3.5 decades. My awesome doc at an excellent NYC teaching hospital did my surgery with the cutting edge daVinci robot. I didn’t demand robotic surgery. I never even heard of robotic surgery before this year. But I do appreciate the dime-sized incisions and the good outcome with zero complications. Do you think Medicaid patients should, by default, get less expensive surgery/treatment instead of the “best”?

      I’m back to work now, BTW, once again paying my taxes from my tiny paycheck from my temporary freelance job with no benefits. I’m curious. How much do you think I can afford to pay for healthcare (but just don’t want to pay)? My pay rate is $19/hr. My check last week was $708 gross/$524 net after taxes. My rent is $1400. How much do you think someone making $10/hr can afford to pay?

      • Eric W Thompson

        I know plenty who choose to not buy insurance so as to keep cable TV, smart phones and etc. Got my first cell phone of any kind last year, flip phone. Works and is cheap.

        Who is paying for the care? I would guess from your description that all of the taxes that you paid combined would not cover the procedure you went through. Someone pays.

        Question: should poor people forego anything? Why should they have lesser cars? Or houses? Why not have the best meals prepared at the best restaurants? Don’t they deserve it as much as the rich?

        It isn’t that you should not get the care, but who pays? As you admit, you certainly aren’t covering it – not close. Most in the USA do not pay enough taxes to cover their share of the government cost.

        Too bad the rich people, who pay about 70% of the taxes, are such awful people. We need to stick it to them I guess.

        No, I am not and never will be rich. I am frugal and don’t believe in taking or spending other people’s money. Not considered an admirable trait in today’s USA.

        • Patient Kit

          I’m sure there are plenty of people who don’t prioritize paying for healthcare. But there are also millions of Americans who literally cannot afford healthcare, even though they’ve worked their whole life.. I definitely make healthcare a priority but I still can’t afford it. I don’t own a home. I don’t own a car. I don’t own a TV let alone have cable. I don’t think your equating good affordable accessible healthcare with expensive restaurant meals and cars is a fair question.

          So, what exactly are you saying? Should I have not received any treatment for cancer because I couldn’t pay for it myself? Do you really think that only people who can pay for every penny themselves deserve medical treatment? Even paying decades of taxes isn’t good enough for you because I “took” more than I put in? So, if you got to decide, who in this country would have access to medical care? And who wouldn’t? And have you or anyone you love ever had a serious and expensive illness? Who, in your opinion, are the deserving?

          • Eric W Thompson

            I didn’t say you shouldn’t have ‘good affordable care’. But is that what you had? No. You had the top of the line care that in Europe only the rich get; not national health care recipients.

            I will say the example you gave was not the norm, way over the top. Most medicaid recipients and many with good health insurance would not receive such care. It did equate to expensive restaurant and cars. So it both was and was not fair.

            You said it, decades of paying taxes didn’t cover it; leading to my actual question, “Who should pay?”. And why is that care different than having a good car? Or a good house and food? Don’t you deserve food, shelter and clothing along with healthcare? Why not the best?

            Rhetorical questions I admit – but pertinent and never addressed here.

Most Popular