Transformations in Care (and a way it needs to stay the same)

The theme of the 2106 CBHD Summer Conference was Transformations in Care and was kicked off by addresses from Cheyn Onarecker and Robert Orr. Dr. Onarecker set the stage for the conference by saying that in medicine today we are in the best of times and the worst of times. He reminded us we are in the best of times in the sense that there are so many things that we can do now for people who are ill that we could never do before, and in the worst of times in terms of the mounting problems with our health care system. In both ways change is inevitable, but we need to do our best to see that the moral foundation of medicine does not change and the dignity of human life is respected.

Dr. Orr gave us a very personal glimpse at the changes in medicine through his lifetime. Health care has new technology, increased specialization, different ways to provide long term care and new ways of financing it. Health care ethics has changed with the rise of principlism and a strong emphasis on autonomy, while there has been an unfortunate change from medical professionals to medical providers, which involves a change from being to doing that we need to resist. He also warned we need to beware of the loss of rights of conscience which date back to Thomas Paine’s Rights of Man and the First Amendment to the U. S. Constitution, but are on the brink of being lost in our society.

I have been reflecting on what they said and on my own experience of change in medicine over 35 years of practice as I sit in my little pop-up camper in a national forest in the hills of southern Indiana watching the rain fall on the beautiful green forest that makes me think of what Eden might have been like. When I began practice in 1981 there had already been major changes in the technology of medicine with ventilators, heart surgery and transplants leading the way, but many of the medicines we use and things we do routinely today did not exist then. Medical practice was simpler. Patients chose the physician they wanted to see and paid the physician directly. If the had insurance,they were reimbursed. The only insurance that paid physicians directly were Medicare and Medicaid. Office visits were a lot less expensive and I only needed two employees for my solo practice. Fifteen years later when I joined a hospital owned primary care group I had four employees plus my wife helping to try to keep up with the insurance paperwork even though I had installed my own computer network and electronic claims filing system. Speaking of computers, in 2002, the same year my camper was built, I talked my partners in our hospital owned practice into being the pilot site for the development of an outpatient electronic medical records system. The experience of being on the leading edge of this change for our system had its problems, but we did manage to trade the daily problem of lost charts for the less frequent problem of having no charts when the system went down.

One thing, though did not change over the years. I remember in my early days of solo practice in Plymouth, Indiana walking into an exam room to see a new patient only to be greeted by a young mother bursting into tears and sobbing, “You’re not my doctor!” After she composed herself she explained this had nothing to do with me, but that she was having a hard time adjusting to no longer being able to see the doctor who had taken care of her since she was child. Her doctor had retired to become Governor of Indiana, and I got to take his place. Years later when I left Plymouth to move to Upland, Indiana so that I could each ethics at Taylor University, I had one older patient after another say something I had not expected, “You weren’t supposed to leave until after I was dead!”

On both ends of my 28 years in practice in that small town people were saying the same thing, we want a relationship. The advances in medical technology can be an amazing blessing. Electronic records and communication can provide access to the information we need to care for people well, but the practice of medicine is at its core about one person caring for the needs of another. As my patients told me bluntly, they want and need a relationship as they deal with illness, aging and all the things we try to help them with in their lives. They need someone to care. There will be many transformations in medicine in the years to come, but we must never loose the caring that is at the center of medicine.

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Joe Gibes
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Joe Gibes

Steve,
Thanks for this great post! As a fellow ex-small town doc, it really resonates. The relationship is what patients what, it puts the joy into doctoring, and it contributes immeasurably to healing.
Joe Gibes

wetasy
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I love this part
On both ends of my 28 years in practice in that small town people were saying the same thing, we want a relationship. The advances in medical technology can be an amazing blessing. Electronic records and communication can provide access to the information we need to care for people well, but the practice of medicine is at its core about one person caring for the needs of another. As my patients told me bluntly,