Everything Goes — by Mike Hoover, MD

Posted: May 3rd, 2012

Everything Goes

 ”Times have changed, and we’ve often rewound the clock, since the Puritans got a shock, when they landed on Plymouth Rock.

If today, any shock they might try to stem, instead of landing on Plymouth Rock, Plymouth Rock would land on them.”

  Anything Goes, Cole Porter, Peru Indiana.

One of the great things about being a senior physician is that you can reminisce about the old days.  Young physicians don’t even have old days to reminisce about.  Even better, it doesn’t make any difference if your memories are accurate or not.  There are very few people around who can dispute your recollections, and if someone does, he’s just a doddering old fool who never knew what was going on anyway.  Nobody’s lying; it’s just that out of the foul and complicated mash (a mule for kick, an anvil for iron) of experience is distilled the clear sweet Kickapoo Joy Juice of memory.

When I got to Evansville in 1978, the doctors’ lounges were almost always crowded.  The haze of cigarette and pipe smoke was heavy, and the ashtrays were always full.  About half the doc’s smoked in those days, and you got so used to the smell you didn’t even notice it.  Primary care physicians admitted over half of the patients to the hospital, and general practitioners (as they were called then) were doing about a third of the surgery.  Some were pretty good surgeons.  Some were pretty bad.  Some were awful.

On the units, I just missed the days when the nurses stood up when the doctor came into the nursing station.  I had never had that kind of treatment in residency, so I didn’t know the difference, but some of the old guys (they were almost all guys back then) still expected it.  Seems like the biggest jerks expected the most deference (not much change there.)  Of course there were no hospitalists, and primary care doctors were in charge of their own patients.  Some were pretty good physicians.  Some were pretty bad.  Some were awful.

But as the song says, times have changed.  The powers that be (government and private payers) long ago decided that the personal physician’s contribution to the care of the hospitalized patient was worth little to nothing.  I don’t know if Marcus Welby died from starvation, or from a broken heart, but I miss him badly.  I can’t quite figure out why today everybody agrees that we need patient care advocates, and are willing to pay for them, but the best patient care advocate the patient ever had (second best actually, family is the best), the personal physician, has been marginalized to the point of extinction.  I’ve been involved in many cases in which the knowledge and experience of the personal physician could have saved a whole lot of misery, not to mention a whole lot of money.  Patients recognize the value, (think concierge practices) that is until their insurance companies tell them that the service is worthless.

But what do I know?  I’m just reminiscing.  I miss the cherry turnovers in the lounge, too, but I don’t think they’ll be coming back.

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