This was a death without a funeral; a slow protracted death that many did not notice until one day we all woke up and realized that the traditional American doctor no longer existed.
The family doctor who once doled out prescription drugs in moderation and offered personal care throughout his or her office, has faded away. Back in the day, we’d stop in the office and were greeted by name by everyone—from the receptionist to the doctor. Throughout the visit, we were the focus, and we felt the staff and the doctor’s concern and caring. We didn’t need to have our photo taken and slipped into our charts so the doctor would recognize us when he or she walked into the room. Back then, the doctor knew us and knew our family.
Some of us remember when physicians made house calls, charged reasonable fees and offered payment plans. They taught us about prevention, engaged in active listening and gained our loyalty and respect because they respect us, too. Through close interaction with these caring professionals, we were encouraged to demonstrate a little personal responsibility in our daily lives and we did so—maybe not so much for ourselves—but because we wanted to please that person we so admired. That very special doctor we all adored has faded into the sunset and is no longer anywhere to be found.
This begs the question, how exactly did this doctor die? It’s a toss-up whether it was murder or suicide because it clearly wasn’t from natural causes. In arguing for murder, we all know the physician/patient process isn’t sacred anymore. It operates within a massive system that includes government bureaucracies and their regulating agencies, insurance companies with health-care plans, hospital systems with ownership over many private practices, the pharmaceutical industry with its long arms of reach and influence and of course, the media, who all consider themselves healthcare experts and rattle on about things they know nothing about.
There is no debating that all the players in the newly created, gigantic and lumbering system contributed to the demise of our beloved family physician. Exactly who “done it” is up for grabs but the weapons are not in dispute. Those weapons included the ever-rising mountains of paperwork, declining reimbursement by Medicare and other providers, protocols set by hospitals for patient care, endless red tape for approving treatments a doctor may have wanted to provide, dictates in patient care driven by what insurance would and would not cover and the rising cost of malpractice insurance—all of which facilitated this death by a thousand cuts. Through it all, many physicians reconsidered their career and some actually left the practice of medicine altogether or retired much, much earlier.
Still, suicide can’t be ruled out either as the cause of death. The medical community’s own behavior that started as far back as the 1940’s has arguably made an impact, too. First, take into consideration that their enormous professional association, American Medical Association (AMA), one of most powerful lobbies in the country, representing physicians, must have been asleep at the wheel because they did nothing to stop the destructive change that was taking place around them. Any other business would have forecast what was about to occur in their field, but this group didn’t have a clue and allowed everything to rollout without considering the effects on their members and patients in their care.
The individual doctors may have done themselves in also with their own overwhelming rush to specialization, which resulted in young interns veering away from general practice and family medicine to those more lucrative and sexy specialties. That mad dash transformed our once beloved family practitioners from the majority (75% in the 1930’s) to a shadow of their former selves (12% today); in fact, you have to look far and wide to find family practitioners anymore because the percentage is so low. They are now combined into a larger group, which includes specialty doctors and they're called primary care practitioners, but still represent (as of 2010) less than one-third of all physicians dealing with patient care (according to the Department of Health and Human Services). Included in the primary care category are pediatricians, geriatricians, general internists (yes, all specialties), general practitioners and family practitioners. The few family physicians, who do currently remain, struggle to compete financially with the specialty doctors earning substantially more. They have killed off their own numbers by deciding the treatment of a person’s body parts is more appealing than treating the whole patient. Now, do you see why I adore wholistic or holistic medicine? Our bodies are too complex and internally interdependent to ignore the big picture. Sorry, I digress (a blog for another time).
So, the American doctor’s demise finally came after sixty-years of self-mutilation and external abuse. While they were self-destructing, there was no one representing the patient’s needs. The patient was the only one with absolutely no voice in the ensuing crime. The result has been the morphing of the healthcare system from being patient focused to becoming system focused. Patients now put up with an average visit with their doctor of 15-minutes or less (according to ncbi.nlm.nih.gov), being prescribed drugs for every symptom the patient presents and not being taught anything about how they can compensate for the declining nutrition in food with the advent of GMO and chemical treatment.
We now ignore our bodies completely and focus externally on whatever quick fix is being promoted on pharmaceutical ads on TV. We settle for a “chronic” diagnosis from our doctor, which always means taking a plethera of drugs for the rest of our lives, instead of finding solutions. Our physicians don’t listen to us and therefore we don’t listen to our bodies. As a society we may be living longer but we are not living healthier.
This eventual demise of a personal system that rewarded both the patient and physician has been replaced by a system that predominately rewards insurance and pharmaceutical companies. Patients are spending more and are less healthy and physicians are more frustrated and disheartened (when you ask them in private). As for the treasured family physicians, their financial rewards are miniscule compared to the specialist groups. Once family practice was driven by creativity, flexibility and the ability to treat their patients as they saw fit; satisfaction and financial rewards followed. Now, it’s limitations at every turn and only modest rewards. For this most valuable physician group, it has been a slow, painful death.
The tragedy of a protracted death, such as this one, is that it has spanned three generations and although the patients have suffered too, most were not even aware of the impending demise. Even though the deceased is the American doctor, that death has taken an even greater toll; it has killed many of its loyal patients in the process.
For a death that maybe no one noticed, perhaps this blog can be considered its much-deserved eulogy.