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.

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