A. B., one of my early partners was an experienced Mayo-trained internist who had practiced long enough, in what was then a rural area, to have acquired a clientele of dairy farmers. A.B. loved his work, enjoyed collaborating with new young well-trained doctors, but most of all prided himself on his skill and his commitment to patients.
He had some quirks. When his dairymen called him at 3:30am, just before going to take care of their cows, and complained of minor problems, A.B. called them back at 11:00pm to find out how they were doing. He and they knew the limits of his patience, but he and they knew his competence, dedication and willingness to take care of serious problems at any time.
One day at 6:30pm, when A.B. was unlocking the practice's front door to allow a patient and her difficult husband to leave, the patient thanked him. The husband said, "Doc, I'll bet you will be unhappy when we have socialized medicine." Without any pause, A.B. replied "Oh no, under socialized medicine I would have been out of here an hour ago."
Today, we don't talk about socialized medicine. Our talk of health care reform, health care efficiency, pay-for-performance, economics, triage and universal health insurance has drowned out discussion of health care provider competence, commitment to patients, ethics and integrity. A. B. was certainly aware of the economics of practicing medicine, but he was never financially rich. When his heart gave out, and he retired, he retold the story of opening the door at 6:30pm, with wistfulness because he knew that the relationship between patients and their physicians was changing: the joy of medical practice was being replaced by the increasing burden of health care efficiency, payment for performance, health care economics and guidelines of care.
A.B. spent as much time with his patients as they needed, day or night; does your physician spend 10 minutes of undistracted time with you?
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