Philadelphia Medicine Summer 2019 - 15

p h i l a m e d s o c .o rg

What did you learn from your time in the Navy?
The Navy was indeed an education. I was a fulltime general
medical officer and got to hone many of the outpatient skills and
practices that I had learned during my PGY1 year.... except the
bulk of my patients were young and healthy. Dealing with Navy and
Marine wives and children did not make for medically interesting
days. (Active servicemen had to line up for sick call with the onduty
flight surgeon.) On optometry days, I learned how to pleasantly
deny free aviation sunglasses to nonflight line personnel. I served
only stateside at NAS Dallas and NAS Corpus Christie, which is
where I learned how to fly. I also learned how to read rank stripes
on military uniforms, and that if you wanted to get anything done
in the Navy, you did not climb up the chain of command! You
simply ask your chief petty officer. Navy chiefs are amazing!

What has helped make you the doctor you are today?
My patients made me the doctor I am today. First it was their
pathology and getting the correct diagnosis, then it was the patients'
mental state and the need to instill in them a feeling of confidence
in my judgment, and finally it was the patient as a friend and
fellow partner in life's journey. Conversations with patients often
involved general health questions and I felt that I had to keep up
with medical advances in specialties not my own in order to advise
patients. It has been wonderful hearing the patients' gratitude for
my responding to their many questions.

What are the biggest changes in medicine you've seen
since you started your career?

In order to relieve the pressure on doctors, the health team is
evolving. CRNPs, MAs, PAs, technologists, psychologists, social
workers, clinical scribes, etc. Doctors are encouraged to utilize these
resources, which are themselves necessary cost centers, and often
limit interactions between patients and physicians. The philosophy
of "Big Data" and "outcome" scoring have led to doctors having to
"check the boxes" as well as to fill the patient note space and diagnosis
codes on a computer screen. And this has created a tremendous
adaptation requirement for us older physicians who would rather
talk to the patient than to the computer screen! Many doctors have
to spend hours into the night entering patient data because, during
office hours, they naturally feel compelled to listen and relate to the
patients who come to him/her for care. Many cases of physician
"burn out" are attributed to EMR and EHR.

What does it take to be a good doctor today?
So, to be a good doctor today, you have to be very knowledgeable,
socially mature, mentally fast on your feet, medically suspicious,
intellectually curious, quick and appropriate with your referrals,
and able to deal with a tremendous workload driven by patient
care and documentation, especially via EMR and HER. Doctors
today need to be results-oriented rather than patient-oriented.This
subtle shift in emphasis facilitates the young physician fitting into
the current mold, digging down to the patient's chief complaint
and quickly moving on. This frees him up to spend more time with
documentation and with his own family than he did in the past.

How are today's med students like you and your peers?
How are they different?

Today's medical students display most of the above qualities.
The biggest change in medicine has been the rise of the corpo- They are enthusiastic and energetic. They care about the patients'
rate health system behemoths, and the rise of government control, well-being, but certainly know the difference between personal
particularly the requirements for EMR and EHR, MIPS, MACRA, family time and patient study time.
etc. The giant systems (Jefferson, Penn, and Tower) now employ a
tremendous percentage of local physicians, and as business entities,
tend to look at doctor "productivity" instead of doctor quality and What one piece of advice would you give them?
empathy. Doctors are assigned specific blocks of time per patient,
and often need to say "see you next time" prematurely and move
As much as I would miss the traditional doctor-patient relaon to the next patient. If a doctor stays over his allotted time with
tionship,
I think I would advise students and young physicians
each patient, he backs up the waiting room and extends his already
to
be
sure
to make a life for themselves at home and continue
busy work day. He/she is encouraged to utilize expensive diagnostic
to
let
medical
science and technology make it easier for them to
testing and facilities even if he feels confident in the diagnosis in
drill
directly
down
to a patient's pathology and get through the
order to maintain the economic health of the institution, and
day
doing
the
most
good for the most people. The traditional
indirectly raise the cost of health care. Consequently, the doctor
doctor-patient
relationship
may no longer be economically feasible,
has to deal with obtaining prior authorizations from health insurers.
but
it
should
be
fought
for
in every possible way. This is a mission
And, of course, the ever-present specter of malpractice liability
of
organized
medicine!
also raises pressure on doctors and forces up health care costs.
continued on next page

Summer 2019 : Philadelphia Medicine 15

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Philadelphia Medicine Summer 2019

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