Impersonal care from the new generation of physicians

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Historically, American physicians and surgeons were fiercely independent practitioners, who owned their own practices, worked long days and maybe longer nights, made a good income, but saw little of their families. They trained in a male-dominated world in “residency,” so named originally because their extended 120 hour/week work schedule demanded them living in dormitory type residence adjacent to the hospital.

They developed long-standing professional commitment to their patients that superceded time for family dinners and occasions. The epitome of this stereotype was the family practitioner, who did everything from delivering babies to removing appendices to setting fractures to making house calls to rounding on in hospital patients.

But times change. “Marcus Welby, MD” is no longer on television, nor in the medical community. The increased complexity of medical diagnosis and treatment has forced specialization of medical practice. But another more recent change in medical culture is just as revolutionary. This new medical ethos is aptly reflected by a recent news story of three generations of physicians practicing in a small community in Pennsylvania. Father joined grandfather in the old school of total professional commitment, but granddaughter (women now majority of new physicians) who grew up with them mostly in absentia has other ideas. She is the new mother of twins and wants a more participatory role in their upbringing, not just a financial provider. She is becoming an emergency medicine physician, working specified shifts as a salaried employee for 36 hours per week with no on call or after hour responsibilities.

The new generation is providing specialized, but very impersonal, care. They do not want to be at their patients’ beck and call and believe a team of professionals provide better clinical care than the individual practitioner. They are exchanging a patient dedicated life for a more balanced, family oriented work ethic. Moreover, the ER shifts provide varied, shorter and more focused adrenaline rushes of professional activity. Medical problems are diagnosed and dealt with in a time frame of minutes and hours, not weeks, months and years.

What does this mean for patients when a new generation of physicians find repetitive monitoring of diabetic compliance, urging weight loss and smoking cessation, and prescribing blood pressure and cholesterol-lowering medication boring and unrewarding? Is it bad that you do not have a “doctor,” but an insurance card that entitles you to a menu of diagnostic procedures, laboratory tests, physical examinations and specialty referrals at specified locations? This is a critical question for cardiac surgical patients (and maybe all patients) because these dull, boring things that younger doctors wish to ignore are just as important as the glitzy, fast paced surgical techniques in determining long term benefit after cardiac surgery.

If the doctors do not want to do it, then patients are going to have to take control of their own lives, be their own advocates and seek help and guidance from all resources available, including possibly a greater reliance on alternative medical practitioners.

Norman Silverman is a cardiothoracic surgeon and founder of Heart Surgery Guide.

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