When the Doctor Goes Home: The Coming Indifference of American Medicine

[Geee]

American Thinker:

It is the close to midnight and your mother is drifting in and out of consciousness. She is 77, not young but not old enough for fatalism. In her darkened hospital room you feel fear and the dread of uncertainty. And then, the doctor goes home.

In the New York Times, a recent article describes the migration of doctors from business ownership to shift workers. In increasing numbers physicians are no longer entering traditional "private practice" but exchanging autonomy (such that it is) for a role as employee of hospitals, large "corporate" physician groups, or universities. Most non-physicians seeing this change are reflexively sympathetic. After all, "doctors are just like us," need predictable days off, personal days, set vacations, and the duality of rewarding home life and well-paying and ego-fulfilling job.
All that makes sense, until severe illness visits. At that moment, in a hospital room at the end of the "second shift" or meeting the "hospitalist" whom you have never seen before, or when calling the primary care physician, who has no clue that anyone is in the hospital, you begin to understand the very different way we will be cared for at times of our greatest need. Most doctors do not want to advertise this nor will patients recognize it until the transition towards a gentle indifference is complete.

I have previously written that physicians must be vigilant and remain consistent with their unique moral responsibilities. Self-reflection and a steadfast commitment to the patient's welfare can right many wrongs. At the same time, however, public attitudes and polices must be able to sustain a culture that both understands and rewards these internal and most personal qualities. Unfortunately, at the very time when physicians themselves are least satisfied, society is forgetting that what you want from doctors when you are well is very different from what you need when you are sick.

Thirty years ago, the training and practice of medicine was deeply rooted in "inherited" values as much as craft. Physicians were in a noble discipline recast into paladins protecting society, even a bit of its soul, against an implacable adversary. Training was both arduous and flawed (inflated egos and autocratic mice that roared) but with a central purpose. When done well, doctors successfully confronted their most difficult internal challenges, fear of the power of illness and the willfulness to make important decisions when the consequence was uncertain. This "old" medical culture was best expressed by a single term: "My patient." It was as far from provider and client as you could possibly get. "My patient" conveyed both bond and responsibility.