I had the good fortune of practicing family medicine from the 70s to the early 10s. It was the Golden Age. After doing a family practice residency in a community hospital and serving a short stint as an assistant residency director, I started out in my practice that lasted almost 40 years. Here is the story of how I got the ball rolling. I was part of a large family practice group. Dr. A was an elderly GP with a devoted patient clientele. His patients loved him. He gave them prescriptions, vitamins, B-12 and cortisone shots. He did use the lab and x-ray but never referred. He would diagnose an MI correctly and then treat the patient with follow-up house calls. He didn’t really know what a cardiologist or most specialists actually did. Maybe he was lucky, but we never heard that many of his patients died. Yet, he was paternalistic and pre-patient education. Our group decided he was a risk and delegated to me the thankless job of convincing him to retire. I was successful, and surprisingly he asked me to take over his patient load. During my practice career, I saw many, many patients that stayed with me my entire career including Dr. A’s patients. They must have sensed some of their beloved retired doctor in my style of practice, and they stayed with me and referred their family and friends. For most of my career, I had a lot of face to face and hand holding time, very little documentation, and minimal outside interference. I delivered babies for the first decade. I was a care coordinator, gatekeeper, and quarterback. I had a broad knowledge of medicine and a good skill level. I was practical and empiric yet didn’t skimp on testing and referring. I played by the book we used at the time. I knew everything about my patients. I always worked them into my schedule for emergencies. I treated their infections, their pain, their depression and many other things. I kept them working and when necessary gave them the permission for respite. When frail, I visited them at home or at the nursing facility, never delegating their care. I certified in Hospice and Palliative Medicine and was also able to provide excellent end of life care. And at the end I quickly became computer and EMR savvy and spoke Epic fluently. What was my reward? Lifelong “friends” that trusted my judgment, lots of positive feedback, and countless letters, gifts and calls of thanks. I had the respect of my colleagues. The ER doctors and specialists were in awe at the scope of my general knowledge, my ability to recall medications and medical histories without referring to the chart, and my thorough dedication to my patients. Eventually, age, employer micro-management, EMR documentation, and insurance/government regulations got the best of me, and I retired and moved away. My patients could not find another doctor that fit my mold and, therefore, were scattered throughout the area for their care, with most establishing with new young doctors. My patients still talk about me, send letters and emails, and update me on Facebook. Despite being gone from the scene, I am still special to all my patients. Not so, when it comes to my former colleagues. Now, not even three years since I left the area, I am regarded by the new generation of doctors in the same way I once regarded Dr. A. The new generation now has their own Golden Age with many advances, new gadgets, digital information, a new idea of work-life balance and evidenced-based medicine. I hear from my former patients that their new doctors tell them they aren’t going to do things the way I did. The new generation has abandoned much of the old practice style, and they often scoff at our lack of knowledge. No, the new generation is better and plays by the “new” book. But to their dismay, the new generation of doctors has to repeatedly hear my former patients defend my old practice style. And my patients report back to me with the responses from the new doctors: “Dr. B was old school and needed to retire.” “He used to see drug reps and was known to pass out free samples to help poor patients.” “He used to prescribe such outdated things like Premarin, vitamin D, and antibiotics.” “He treated UTIs, conjunctivitis, colds, and bronchitis at times without seeing the patient.” “He did routine mammograms, PSAs, vitamin D levels, physicals and other unnecessary things.” “He gave out a lot of pills — for pain, sleep, anxiety, depression.” “ He used to enter the office through his waiting room and sometimes even sit there and visit with the patients. True, he knew his patients and their families well but he probably broke a lot of HIPPA rules in the process.” I can’t think of another profession where the practitioners from the previous generation are held in such low esteem. Former athletes are still remembered, admired and honored even though the training and equipment have improved the stats. Former pilots are well respected by the current generation of aviators who realize they have it a lot easier nowadays. No one puts down a former teacher or CPA by casting doubts on their ability to read or to add. Medicine is a field where rapid changes in technology and information make previous treatment and practices obsolete. I get that. Now that I am partially retired, I finally have ample time to read and think and evaluate. I know the “errors” of my ways but knew of no other ways back then. I know much more now about screening and testing and treating diseases. The point is, that’s the way the medical profession is. Technology and knowledge change from generation to generation. I understand and accept that the new generation of doctors can’t practice with the old knowledge or the old technology or in the old style. They inherit a broken healthcare system and patients with antiquated expectations. I am sure some good things are still said about the departing generation. I had my Golden Age. But I regarded Dr. A the way the new generation regards me. And the new generation of doctors will in turn be judged in a similar manner by the very next generation of ultra-smart doctors who will be heard to say about their predecessors: “Those millennial doctors were so behind the times. Imagine using toxic drugs and harmful treatments. It’s hard to believe they didn’t capitalize on nanotechnology, gene repair and manipulation, personalized medications, and robots!” “Dr. B” is a family physician. Source
