Friday, August 31, 2012

Whatever happened to personal contact?

Not long ago, I attended a retirement party for a former colleague. He had been a surgeon for 43 years at a hospital where I was once chairman of surgery. A number of old friends and colleagues whom I hadn’t seen for a long time were there. The event was so enjoyable that I said to the guest of honor, “This is a great party. You should retire more often.”

Later that evening, my wife, who is noted for profound observations, remarked that it is too bad that we don’t see people in the same way anymore. She pointed out that although we interact electronically in so many ways, we aren’t as personally connected to many of our friends and acquaintances as we once were.

That led to a discussion of the atmosphere permeating medicine today. Back in the day, physicians used to socialize more. In most hospitals, there were doctors’ dining rooms or designated tables in the cafeteria where a rolling group of docs from many disciplines would have lunch and chat about difficult cases, the hospital administration, politics and many other topics.

There’s no longer a need for such things since no one has time for lunch nowadays and the hospitalist movement has succeeded in eliminating the primary care doctors from the hospital environment. I have been practicing at the same hospital for over three years and have never even met 95% of the local primary care docs.

Something is lacking when you aren’t able to attach a face to a name.

Are these are just the ramblings of an older doctor longing for “the good old days”? Or is this another reason why a lot of us don’t enjoy practicing medicine as much as we used to?


Josh said...

As someone just entering practice in a new community, I can't help but think of how what you are talking about here impacts a new physicians's ability to join a medical community (if that's not too oxymoronic given what you've written), gain trust and reputation, and ultimately alter referral patterns to establish a practice. On the contrary, if I become an employee of a large hospital system, facelessness has less of an impact because my image is tied to the image of the system (regardless of whether I deserve it or not). All part of the trend towards dehumanizing medicine in general.

Skeptical Scalpel said...

Josh, good comment. I agree. And it's going to get worse.

Felix said...

It could be part generational but really is also about technology. For example, When my managers ask me about the job of the Account Executive in the energy industry, I tell them we are like "general practitioner doctors" in ER rooms Our "patients" are the buildings and the people who operate those buildings. In order to really find out what's going on inside of a building, I have to visit that building and look at its innards, the lungs (air conditioners and fans), the veins (the pipes and wires), the skin (the building skin or facade including the glass) and the overall environment in which the building and people operate (the climate zone and its temperature). Then I ask about the pulse of the building and how it operates, how its feed by the local electric and gas utility, etc.

My point here is all this takes a personal visit to the building and its facilities. It allows me to better understand what's going on. As a matter of fact, there is a movement to look at buildings and how the operate in a more "holistic" whole building manner.

However, there is a trend. I was trained as a specialist-generalist in that I got certificates and degrees in science and engineering. However, newer Account Managers are more generalists. Instead the technical side is farmed out to other specialist engineers and subject matter experts. Yes, the older general practitioners like me are about high-touch and high-tech. The newer set of Account Managers are way more high-tech and I have to admit depend a little too much on email. BUT there are efficiencies to be gained by technology. What's happening is I see more customer-focus groups and HMO type building managers erupting. Instead of the single building owner working with me (the patient), I usually work with his/her agent because time is money. Sorta. When a real emergency hits, there is no doubt the real customer (the patient) wants me involved. And typically the older and more experiences general practitioner Account Managers like me are called in to solve the hard problems. Most of them mission critical in nature. I hope this analogy works in some ways.

Skeptical Scalpel said...

Felix, thanks for the interesting look at the similarities between buildings and people. I had never thought of it that way.

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