When Dinosaurs Ruled

My family physician is tall, bald headed, wears wire rimmed glasses and looks like an eagle. He is the head of a four person practice. He makes house calls in the dead of winter to see elderly patients who live in triple decker houses and can't come to his office.

In his office waiting room, there is an ashtray containing white matchbooks with a black skull and crossbones on the front cover. On the back cover, is the emblem of his district medical society. His is the only doctor's office where I've seen such a powerful statement made against smoking.

My family physician limits the number of office patients to 15 per day with only one new consultation, because he believes he "can't do a good job," if he sees more than this. He spends as much time with each patient as needed.

The young physician works in a large group practice; he sees 40-50 patients per day. He is often "triple booked" (i.e., has three patients in different examining rooms at the same time) and is expected to talk to a patient, examine him/her, diagnose and prescribe treatment in 15 minutes (or less). One physician in this group refuses to see AIDs patients; another refuses to see nursing home patients; a third threw up her hands in the ER on a Friday evening when she was on call and got a third GI bleeder in a row to admit. A fourth physician put a hole in her office wall with her phone.

My family physician dictates notes after seeing each office patient; his secretary puts the typed summary in each file, so that his findings and recommendations are totally legible, even though his handwriting is beautiful. After forty years in practice, he has never been sued, because he talks to his patients and considers taking care of them a partnership.

A Wall Street Journal article mentioned a United Healthcare program that allows employers to give financial incentives (e.g., lower co-payments) to workers if they choose "performance physicians" i.e., those doctors who provide higher-quality, lower-cost care, based on the program's criteria; these physicians (an average of 25%) are given "stars," based on two years' of insurance claims data. If these doctors deserve stars, then my family doctor deserves a "constellation."

My family physician has saved the lives of at least three people I know, including my father's. In spite of gallbladder attacks, my father went on a business trip to Mexico. While there, he became jaundiced. He flew home and underwent a cholecystectomy. Post-operatively, he became delirious; his doctors thought he was having an adverse reaction to Demerol, a pain medication. My mother knew something was terribly wrong and asked for an emergency consultation. He called her that night and said: "Mrs. Riefler, I've changed your husband's medications and done everything I can do-now, he's in God's hands." The antibiotics he prescribed saved my father from death due to an infection in the bile ducts. From that point on, my father started to get better. My dad was 48 years old- he is eighty-five now.

He lies in bed at night thinking of the treatment he recommended that day for his sickest patients; he "plans for the worst and hopes for the best." His patients trust him, which is the basis for the physician-patient relationship. They also love and respect him.

He was awarded "Humanitarian of the Year." No one deserved it more.

The empathetic physician appears to have become extinct, replaced by a technician ready, willing and able to stick tubes, endoscopes or instruments into the human body to diagnose or treat. The 'dinosaur' physician would have been an intimate friend or confidant.

I would like to propose a new definition of dinosaur-namely: one who knows his/her limits, never compromises on patient care and should not be allowed to become obsolete.