What this man needed was a doctor!

The Person Was Inside the Patient, but the Doctors Never Met Him

What the doctors never really seemed to appreciate was that Bill was much more than a dialysis patient. He knew the half-life of radioactive phosphorus, where all the soldiers had fallen at Verdun, when to underlead an ace at bridge. He knew where every country on the map is, or was, and what it was called then or now. He knew the name of the captain of the doomed cruiser Indianapolis, whether the Brahms octaves were being rattled off without a dropped note, how the young Joan Sutherland became a diva.

Bill had a lethal tennis backhand, played the piano beautifully, never got lost while driving, understood the innards of a cancer-therapy machine and had friends in most of the 50 states.

But he couldn’t keep track of which doctor was in charge of what. He couldn’t understand why doctors were so slow to call him back and why they didn’t talk to one another. Why didn’t they check on the medications they had prescribed or someone else had unprescribed? Why did he need this new test, which the other doctor said he didn’t need?

Most of all, Bill never understood why all these nice doctors didn’t have a few minutes to talk to him.

Current medical practice has borrowed too much from the industrial model. We talk about productivity, RVUs (relative value units), and billing codes. We rarely have time to talk about patient care.

Over the past 5 years, I have transitioned from a part-time outpatient practice with 2 months a year of ward attending, to doing 5-6 months each year of ward attending. In the hospital I have a better chance to know the patient. I can role model the doctor patient relationship without worrying that my “productivity” – oh, how I hate that word – will suffer.

We need to return to first principles. The reason we became physicians was to care for people, not patients! By that I mean, caring for the patient, rather than the disease.

We need a revolution in our thinking. This revolution actually is occuring in retainer practices and cash only practices. Patients will, I believe, be willing to pay a reasonable amount to get personalized health care.

The patient in the story above needed a conductor. He had wonderful performers from various parts of the symphony, but that symphony lacked a conductor. We need a health care system that pays the conductor. We, general internists, make great conductors. We like that role. We just need to understand how to make a living doing what we know is right and what patients desire. That is my wish today.