In the winter 2014 edition of “Pharos,” the publication of the Alpha Omega Alpha Honor Medical Society, there appears the article entitled “Fall from Grace,” by J. Joseph Marr, M.D. Although offered by “a retired academic physician and business executive,” Dr. Marr offers an excellent review of the progress of Medicine and particularly of the voyage of physicians during the last 60 years.  I can also address this course, as a privately practicing clinician for the last 57 years … and counting.

My comments will be of little value unless the reader has studied Dr. Marr’s article, which I recommend particularly to younger physicians … since older doctors have lived it and are continuing to live it.  As will immediately become evident, I disagree with the author’s conclusion, beginning with the title of the article.

  1. We have not fallen from Grace: We are being pushed. But we will have a soft landing, if only we can survive the next few years.
  2. The subject matter brings to mind the title of three songs: “9 to 5”; “I Surrender, Dear”; and “I’ll Do It MY Way”.
  3. “…from shaman to skilled labor”.  Wrong.
  4. Dr. Marr rightly indicates that many physicians have been “complicit” in the changes that now challenge physicians. But he wrongly attributes this to “hubris.” The real error in physicians’ approach has been their understandable desire to protect their patients from the adverse effects of those changes, rather than allowing them to feel their own pain – and to thus be motivated and politicized to resist.
  5. The nexus of physician / nurse / patient, with the legitimate addition of physician extenders, survives as the indispensable core of medical care, with the physician as the diagnostician and coordinator of that care.  That the physician now can supervise and guide the work of several non-physicians enhances rather than diminishes the physician’s central role in the process.
  6. “Patient visits per unit time”: a corrosive idea. We learned in medical school that, of the three attributes that a physician can offer his patient (ability, affability and availability), the most important is availability.
  7. Yes, younger physicians are different … as are their entire generations.  It remains to be seen whether these younger MD’s, the  “9 to 5’s,” will have the foundation, the grit and the joy of practicing Medicine for the many decades that their older colleagues embrace – despite the current “troubles.” Or will they succumb, not as much to “burn-out” as to ennui.
  8. And that brings up the future. Demography is Destiny. Patients will increase in number, age and debility. Physicians will decrease in number and commitment. But those who remain will be highly valued and appreciated for their knowledge and for their devotion to their patients. They will be sought out.
  9. And, so, I end with a quote from Dr. Marr’s fine review, and with my reaction:

“The physician will become – has become – decreasingly the guide and guardian of the system and more and more of a supervisor in the mosaic of provision of care.” Wrong.

George A. Sprecace, M.D, J.D., practices in New London.

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