OPINION
DOCTORS' Lounge
be time to step aside.
Before I comment further on any possi-
ble consequences, a disclaimer is in order.
My comments are the result of personal
observations and conversations with prac-
ticing or recently retired physicians. I have
no supporting studies or expert opinions to
verify my observations. That understood,
I have observed that as a consequence of
what is outlined above, there appears to be
increasing early retirements, a decrease in
the attractiveness of the medical professions,
a decrease in job satisfaction often leading
to burnout and, among older patients, a de-
creased satisfaction with their medical care
as a result of a decrease in person-directed
care. Is this a confirmation of “optima dies…
prima fugit”? Or, was Epictetus, the ancient
Greek stoic philosopher correct when he
wrote: “Make the best of what is in your
power, and take the rest as it happens.”
Nevertheless, concerning these subjec-
tive comments, some will ask (and rightly
so) where is the body of proof or justifica-
tion? Webster defines proof as “evidence
that compels acceptance by the mind of
truth.” Also, proof can be defined as “a pro-
cess or operation that establishes validity.”
Perhaps this could include statements and
confessions reported by fellow physicians
who are struggling with change and by pa-
tients who are also facing change.
Prior to retirement, I practiced pulmo-
nary and critical care medicine for more
than four decades, and during the last de-
cade (probably more), the majority of my
patients were at or approaching Medicare
age. On numerous occasions, those patients
expressed disappointment by stating that
their physician “spent more time looking
at the computer than at them,” and I recall
one patient who reported that their physi-
cian “didn’t look at me or even touch me at
all.” I do not think that these reports were
criticisms, but rather expressions of disap-
pointment and a longing for “the good old
days.” I also recall a recent conversation
over breakfast with a cardiologist colleague
who has practiced since 1996. My cardiol-
ogist friend, whose practice is owned by a
nonprofit corporate organization, reported
that for most of his years of practice he has
made an effort to adhere to and follow the
suggested practice goals of “state of the art”
medicine coupled with an effort, support-
ed by his employer, to conserve medical
resources. And, much to his surprise, he
was recently cited for poor productivity
numbers. This, no doubt, is the conundrum
that most medical practitioners now have to
navigate. But one example does not establish
validity. However, without a doubt, there
are numerous other physicians who report
existential crises precipitated by the imposi-
tion of time constraints as well as continued
demands to ever increase productivity.
What physician who is steeped in the
history of medicine as an independent pro-
fession, hasn’t bristled at directives handed
down from insurance companies, employers
and practice managers? There is also a per-
sonal example as well, as that of a former
senior partner and a senior family practi-
tioner, all of whom, myself included, elected
to drop out of hospital practice one or more
years prior to electing to retire primarily
because of difficulty managing the requisite
computer.
To summarize, changes happen (always
have). What can one expect as a conse-
quence? Some adjust and resolve to con-
tinue the practice of medicine, some retire
and some continue to struggle with anger
and irrational expectations. It is my hope
that the cited examples represent “a process
or operation that establishes validity” of the
argument attempted in this essay.
to border on the radical and are possibly
conducive to early retirement. But, realisti-
cally, is that not the way it has always been?
Every generation has to walk the razor’s edge
of change. I do not think that Sir William
Osler (1849-1919) would feel “at home” in
today’s medical world, nor do I think that
Dr. Osler would disparage the way medicine
is practiced today. Nevertheless, to many
physicians, the navigation of change is diffi-
cult, and it often leads one to conclude that
“the best days are the first ones to flee.” Or,
was Oliver Wendell Holmes on target with
his conclusion: “The greatest thing in this
world is not so much where we are, but in
what direction we are moving.”
For those who started the practice of
medicine 50 years ago (give or take), today’s
changes are stressful. Some retire, some be-
come bitter and some adapt. But, it has been
noted that there has always been change
be it good, bad or indifferent; and one can
take comfort in the fact that the profession
is, and has been, able to endure change,
and it has endured for most of its history
remarkably well. This is good news for the
retired physician and senior citizens who
may require medical care in the not too
distant future. Perhaps another quote from
Virgil is apropos: “Endure the present and
watch for better things.” And, all can take
some comfort in the fact that new genera-
tions of physicians continue to show up and
ask: “What change?”
Dr. Lloyd is a retired pulmonologist.
In no way do I suggest that today’s pa-
tients are receiving inferior medical care,
nor do I intend to suggest that care today is
substandard. The opposite is most likely the
case. What I suggest is that there is a change
in the way medical care is delivered; and to
many older physicians, the changes appear
FEBRUARY 2019
29