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Sunday, March 13, 2016

Fans vs patients - what is the distinction?

As I'm getting ready to go back to my day job (as a physician), and getting ready to leave my avocation (as a writer), some thoughts occurred to me. And the thoughts had to do with a couple of rather distinct groups of people, who share some similarities, and rather profound differences.

Now let me make myself clear - this is my own thinking, and others have some definite differences of opinion. First let me tell you about my patients. It used to be, when I first started in medicine, that I "grew" a group of people whom I considered my patients, and who in turn, considered me their own doctor. These people were extremely highly regarded, and I would do anything at all for them, which included getting up at all hours of the night to see to their needs. These persons were, in turn, extremely loyal, and remarkably forgiving. I did get paid to take care of them, and they were by and large willing to pay for my services. I did get to know them and their families, and together we weathered some remarkable times.

That was then - and now things are quite different. Somewhere along the way, it got to be apparent that things were going to have to change. The reasons for the change were subtle at first, and became much less so as time went by. I found myself an employee of a hospital, and as such, the payment for my services became very indirect and extremely impersonal. Yet I was still putting in very long hours, and getting paid less each year for doing so. And I had to make a decision as to whether I wanted to continue to practice office-based medicine (and as such retain my long -term relationship with my patients), or whether to go to strictly a hospital only practice, and to give up the long-term relationships I had so assiduously developed. Well, I made the leap to hospital-based medicine, and in doing so the fact of being "my patient" became a remarkably evanescent thing. And now, it is even more evanescent, as I'm working shifts, and I "hand off" my patients to another hospitalist coming on. This has some good things going for it - mainly that there is always a physician on site to care for the patient's needs. But it also has some definite drawbacks in terms of relationships.

Now I just came back from the national meeting of The Society of Hospital Medicine, and it turns out that there are now roughly 52,000 + hospital-based medical practitioners (how I despise that term) in the USA. And one of the things that was stressed repeatedly is how we now practice evidence-based medicine, and how this will improve patient outcomes, and lead to more satisfied "consumers." Now, thinking back to when I got started, people were much more satisfied then with their medical care, and if they, for some reason or other, did not get along with their doctor, they could find another. Contrast that with the sick patient who is hospitalized today, and finds that "his or her doctor" does not admit patients to the hospital, and that he or she will be at the mercy of someone who very likely has never seen them before, and they have essentially no say in the matter.

Contrast that with my other vocation as a writer. Here we have a multitude of people who have an alarming number of choices, and a few of them become "my fans." This is purely a matter of choice, and if I continue to produce printed material that they like, they will continue to be my fans. It was refreshing to go to a book signing event this past weekend at which several persons identified themselves as my fans, and eagerly bought my next book. And I was thinking, perhaps it was this which I had been seeking since embarking on this road trip I like to refer to as becoming an author.

Oddly, it felt somewhat the same as it did when I first left residency, and developed my own patient base. Very strange...

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