It's Sunday night. The kids haven't practiced piano yet. Their rooms are a mess. The laundry isn't folded and I'm not completely sure that everyone's showered today. I couldn't care less. I am proud of myself and my family. This weekend we worked hard and played hard. We spent Saturday cleaning out the garage and went out for ice cream afterwards to celebrate. Today, we spent most of the day outside flying kites, taking a walk, and riding bikes. The biggest problem I confronted all day was negotiating the kite string out of a neighbor's tree.
Weekends like this make me realize the emptiness of what I too often spend my time on — whether that's getting overly bothered by clutter in the mudroom or wasting time on electronic pursuits. Tonight, I remember that to-do lists aren't nearly as important as just enjoying my family and the time we spend together.
Sadly, I think medicine is losing the equivalent of a lazy Sunday afternoon. As financial balance, technological advancement, super subspecialists, and centralization encroach further into the arena of medical practice, we are losing some things. When I was growing up and you called your family doctor's office, you spoke to his nurse. She knew you. She was personable. She massaged the schedule, if needed, to get you in for the strep throat or the camp physical. Once upon a time, I had a nurse like that too. Now our nursing staff, while still populated by talented and dedicated people, is centralized. They are responsible for answering the calls and questions of thousands of patients. If they happen to know you by name it means you are very sick, very rude, or desperately want more narcotics.
When I first started out in family medicine, not that long ago, I delivered babies, took care of my hospitalized patients, did flexible sigmoidoscopies and colposcopies, and stopped by the ER to see my patients. While many family physicians still do all of these functions, the number shrinks each year. Even as a family doctor — the very definition of a generalist — I can feel the pressure to specialize in chronic disease management and preventive healthcare. So onerous are the laundry list of tasks and tests I need to perform for my patients, that I am in danger of losing the human connection I so enjoy.
For all the benefit of scientific advancement in both medicine and my personal life, I wonder at what we've already lost and what we are in danger of losing in the near future. It's still possible to maintain a personal, humanistic connection to patients in an era of meaningful use and quality metrics just like it's still possible to spend a sunny afternoon flying kites in an era of Facebook and iPads. However, with each new advancement, opportunity, goal, invention, or novelty, it becomes increasingly challenging to hold onto the best parts of what we do as doctors and what we enjoy in our personal life.