Great ice cream and no spoon. I still love the 21st century


Going back doesn’t sound like a blast,

Sure, time is moving too fast.

There were things to endure

That now we can cure.

Nostalgia’s a thing of the past.

Synopsis:  I’m a family practitioner from Sioux City, Iowa.  In May 2010, I left my position of 23 years, and honoring my non-compete clause, traveled for a year doing locum tenens work.  In June of 2011 I joined up with the Community Health Center, which provides care for the underserved.  I’m now working part-time, which, for a doctor, means 48 hours a week.

Doctors tend to suffer from nostalgia.  Many of us express a longing for the good old days when having MD or DO after your name automatically brought you respect, a simpler time, before technology kept butting between the doc and the patient, when government and insurance companies didn’t interfere with clinical decisions.  Sometimes I’ll say to a colleague, “Pick a year, any year, not this one.  When would you rather live and practice?”

Don’t get me wrong.  I resent the second guessing by health care bureaucrats, whether private or public.  Clearly physicians rely too much on MRIs and not enough on physical examination, and the constant fear of a lawsuit detracts from every patient encounter. 

But I don’t want to go back. 

Immunizations have done away with more than 80% of the pediatrics problems leading to hospitalization in 1982, the year I finished residency.  I can now distinguish between a true positive TB skin test and a false positive from a BCG vaccination(given in another country) with a test called IGRA.  Testicular cancer patients now have better than a 90% chance of cure.  PET scanners, more available now than ever before, show up malignancies with incredible accuracy.  Outpatient surgery has become the norm. 

We can cure schistosomiasis and we can treat rheumatoid arthritis.  Cure rate on Hepatitis C has gone  from 10% to 60% in ten years.  We have good, solid drugs for alcoholism and nicotine addiction.  The generic $4 list includes a lot of medications that used to fetch three figures a month.

In addition to the incredible technology and the great pharmaceuticals, we have consultants of unprecedented caliber. 

I’m fond of saying that if you want 1990’s medicine you can have it at 1990’s prices or lower, but you have to pay for the updates.

Our clinic has a contract with a program for the medically indigent.  Briefly, we get $20 per visit for patients who can’t pay for medical care.  If they need services outside the range of primary care, we can send them to fine specialists 4 to 6 hours away.

The program looks great in theory but the execution leaves much to be desired.  Some of those patients have to drive 2 hours to get to me.  Scheduling referral services involves a faceless, glacial bureaucracy. 

The geographic imperative rears its ugly head; a six-hour drive represents a huge barrier to quality care, no matter how great the facilities at the other side of the state.

On the one hand, the drive deters overuse of medical care.  On the other hand, I worry that my patients may suffer lasting harm from treatment delay, that the system offers too many opportunities for the ball to drop.

Twenty-first century medical advances have made medicine an incredible profession, but economic realities present huge frustrations.  Like having the world’s best ice cream and no spoon.

I still wouldn’t want to practice in any other era.

 

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