Minimal access surgery has been a good thing , except that patients do so well they often don ’ t follow up afterwards . Therefore , it is harder for surgeons to build good relationships with them as patients , and many young surgeons feel like assembly-line data entry clerks . I also wonder who might be around one day when someone calls into the ORs , “ Is there anyone here who can still do a difficult open gall bladder ?”
Those problems are unique to surgery , and I think will be solved eventually in some reasonable way .
Some of the previous solutions are certainly two-edged swords , the worst of which I think has been the electronic medical record . Fortunately , I missed a lot of that personally . As one young surgeon told me in a meeting just before COVID-19 became a problem , “ The EMR is a curse on the medical profession and a blight on the planet .” University Surgical Associates ( our group ) has had to endure four different EMRs inside a decade . It is a terrible theft of doctors ’ time , the endless repetition of data is maddening and not valuable , and you cannot find anyone ’ s personal assessment without wading through it all . I tried to help some of our medical students last year with current reviews of surgical charts , which used to be the cleanest , neatest and thinnest . Now they are very difficult to work with and you lose track of patient follow-up as you move from EMR system A to B to C to D and beyond , I hear , soon .
Things have also changed a lot in terms of medicine , as a whole . I have counseled 4,000 or so young people about careers in surgery , and since about the 1990s , things are changing so fast it is hard for me to even to imagine their lives 20 years from now . They will have to adapt , adopt new ways of doing things , unlike anything I have yet seen . It used to be , if you were going to be a general surgeon for 30 years , you knew what you had signed up for .
Here in Louisville , or in Kentucky , you are going to take whatever specialist is the most available person through your health care system . It is hard for a physician working only in the office - they never even go to the hospital in the first place , to find out who is good at what they do . They rarely see the consultants in person or get to know them . Among the best lessons I have ever learned was to have breakfast in the Norton Cafeteria . Many weekday mornings I met with many referring doctors , and that sure crossed over , it helped us in 1971 through 1975 or so , in first building a practice at the University .
Dr . Polk on Bedside rounds , University of Louisville Hospital , circa 1991 . Painting in the Department of Surgery , given as a gift from previous residents .
DOCTORS ' LOUNGE
What has really changed surgery is advanced imaging . CT scans , MRIs , ultrasounds at the bedside , all of these things are money-spinners out of all proportion for the hospital . The benefit is great , but their cost has been massively out of proportion . I do not need to get started on the price of medication , which is the darkest of black holes . The massive pharmaceutical and medical device makers ’ profits overload the government , and the net effect is to devalue physicians in the whole health care process . Nothing could be worse ! In fact , Big Pharma has more lobbyists in Washington than the National Rifle Association . President Obama made a huge mistake by not nailing down cost-controls on medicines and devices before expanding Medicaid . Anybody can be a Monday morning quarterback , but that was a catastrophic mistake , and the clock will never be rolled back .
In August , I lost my great friend and colleague Dr . David Richardson . It would be worthwhile reading for all of you , the many eulogies paid to him through the various and sundry media related to horse racing . We should share with doctors as a group , and also with the many students that he helped .
When David and Suzanne moved here from Eastern Kentucky , by way of Lexington then San Antonio , Texas , they were “ quietly proud ” of what they had been able to do , and certainly David ’ s career soared . Suzanne ’ s own health was not good but David worked tirelessly with generations of doctors in this Medical Center and across the state . He was a great role model as a clinician , and he was a wonderful person . His faculty career was remarkable - quadruple boarded - and later on he accepted the considerable burdens of leadership of organizations who are typically like herds of cats . Our friendship evolved over horse racing , and the breeding and racing of two mares , Mrs . Revere and Northern Emerald , kept us humble . I ’ m reminded that the amount of determination it takes to be a good racehorse is like that of a good surgeon . David ’ s beloved time in Saratoga cost him six weeks out of the year for the last 30 years , but he sure made it possible for me to join him there . Susan and I work in a short trip to Susan ’ s family graves , which are about 100 miles south of Saratoga . It is a tragedy that both Suzanne and David died up there . There is simply no amount of print , or time , enough for me to tell you all the wonderful things he did , largely unselfishly , for medicine , Kentucky and horse racing .
More later , next issue !
1 https :// www . courier-journal . com / story / news / crime / 2021 / 01 / 01 / louisville-violence-173-homicides-and-few-answers-record-year / 6540016002 /
Dr . Barry is an internist and Associate Professor of Medicine ( Gratis Faculty ) at the University of Louisville School of Medicine , currently retired and mulling her next moves .
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