Physician as lone practitioner | The Health Culture

Part two of the interview with me at Inside Surgery appeared today.

There are questions on the writings of Atul Gawande, physicians who tell-all about their patients on their blogs, and how the practice of medical care has come to seem more like shift-work than the venerable profession it once was. Here’s an excerpt from that last topic.

In 20th century America, business and industry became bureaucratized and were subjected to outside control. The medical profession held out against this change for a very long time. It argued that the doctor/patient relationship was special and unique among professions and should be under the control of doctors and patients, not outside bureaucracies.

The medical profession may have also been concerned about loss of prestige and income, but the sanctity of the doctor/patient relationship was central to resisting external control. This more or less committed the practice of medicine to the model of the solo practitioner.

That model didn’t survive 20th century advances in medical knowledge and technology. The lone practitioner was overwhelmed with information. I was just reading something from a 1910 JAMA on the plight of the physician: “For the overworked physician to steal an hour for the perusal of Carlyle or Coleridge when he ought to be ‘reading up’ an obscure case seems a sort of professional suicide.” And that was only 1910!

As medicine had increasingly more to offer, the demand for medical care increased. Ultimately the solo practitioner model was unable to meet the health care needs of the nation.

Bureaucratized shift-work is not good for doctors and it’s not good for patients. I don’t know what the solution will be. Primary care doctors are asking to be paid by the hour, not for piece work. That might help. The wealthy can afford concierge doctors. Maybe something will come out of the medical home concept. If doctors and patients get unhappy enough, perhaps a creative solution will evolve.

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Photo source: The Renaissance Chick

Jan Henderson, PhD – Medical Historian and Blogger (Part 2 of 3), Inside Surgery, August 18, 2010