By Steve Simmons, M.D.
Steve Simmons, M.D.
In the early 70s Marcus Welby MD, embodied the expectations of patients and the hopes of doctors seeking to emulate his bedside manner. Sadly, when we look at medicine today, patients and doctors alike are left wondering what happened to Welby’s style of patient-focused medicine. Much has changed in healthcare during the nearly 40 years since the show first aired. Patients are more informed and expect to be included when clinical decisions are made. Insurance companies and government bureaucracies have wrested control of the patients from their doctors. Doctors must now focus on business and mind-numbing paperwork to the detriment of their medical knowledge and patients. Runaway costs and an impersonal health care system dominate the landscape of the early 21st century.
The interests of the patient should be paramount and the doctor-patient relationship sacrosanct; however, by inviting a third party into this relationship the interests of the patient are frequently subverted. The office meetings of the past, where difficult medical cases would be discussed, have been replaced with business meetings, insurance coding seminars, and a parade of experts reminding physicians to sit during the office visit to create the impression of more time being spent with their patient. The inevitable frustration patients feel is directed towards their physician, who in turn has been saddled with his own frustration trying to merge ethical and business concerns.
Doctors are leaving primary care in droves, half planning to work less, become administrators, or retire. A survey of medical students discovered hectic clinics, burdensome paperwork, and systems that do a poor job of managing patients with chronic illness as reasons for not choosing primary care medicine. Only 2% of students plan to select general internal medicine as a career. Most students are becoming specialists, where they can make more money, glean respect, and better control their schedule. If national healthcare becomes a reality, today’s critical shortage of primary care doctors will become problematic when the uninsured start looking for a doctor.
What qualities do we want in a primary care physician and what role do we need him to play in our lives? A succession of TV doctors: Welby, Hawkeye, and now, House, share the virtues of diligence, attention to detail, and moral courage. They can help us track the evolution of our patient’s expectations over four decades. Dr. Welby’s patients willingly followed his guidance and instruction, while Dr. House’s patients live in the Information Age and have probably searched the internet before seeking his help. Unfortunately, the admiration felt for Dr. House helps demonstrate that an entire generation expects an aggressive and uncaring doctor, thinking it the norm.
In 1979, Alan Alda gave the commencement address at Columbia University Medical School, titled, “On Being a Real Doctor.” He said, “We both study the human being and we both try to offer relief–you through medicine, and I through laughter–but we both try to reduce suffering.” Few believe today’s healthcare system is focused on suffering. Third party payers are holding on to the money, controlling care, and this influences doctors. Patients like physicians have lost focus on what really matters: to ease suffering.
I sometimes imagine Dr. Welby practicing medicine today. Towards the end of his day I see him sitting behind his desk, entangled in red tape, frustrated by his inability to untie the knot binding medical and financial realities. His waiting room is full of patients, dragging the same red tape behind them.
Fortunately, if one doctor’s argument is correct and all primary care physicians are Marcus Welby, we have reason to hope. Our healthcare system is broken, but not irrevocably. Doctors and patients can stop wrestling against their constraints, turn away from their frustration, and find each other. Patients will use access to information and drive health reform forward; many are speaking up today. Doctors would do well to remember we are all patients but the onus of explaining the healthcare crisis and proposing meaningful change falls on physicians. In our practice, doctokr Family Medicine, we try to cut red tape wherever we can, striving for an open and transparent practice, placing the doctor-patient relationship central in everything we do. I believe you can find a doctor like Marcus Welby in your community and hope our posts will encourage you to try.
Until next week, I remain yours in primary care,
Dr. Steve Simmons, doctokr Family Medicine