Auld Lang Syne
All generations seem to yearn for “a simpler time”, even though such a time really never existed. We all want to go back to “the good old days” even though they weren’t that good. Everybody complains about congress, but according to the movie “Lincoln” it’s always been a bit of a mosh pit. People reminisce about the old days in medicine too, “when doctors were doctors and given their measure of respect, etc. etc. etc.”. There seems to be this impression that medicine used to be a noble profession respected by all, it’s practitioners pillars of society and their word the law. Alas, with the rise of “patient autonomy” those good old days are gone, so say the old-timers.
My parents recently got me hooked on a TV show called “Doc Martin”. It’s a show out of the UK about an eminent surgeon who becomes ill at the sight of blood so he moves to a small town on the coast to be the town’s general practitioner. The town is peopled with the usual quirky and hilarious characters, but the star is the doctor, who is your standard curmudgeon. He hates dogs and children, jumps to diagnostic conclusions prematurely, tells patients to ”shut up” and “get out” on a regular basis, and has the bedside manner of House. He says to patients all the things we doctors occasionally would like to say but professionally never would, like the obstetrician in the movie “Knocked Up”. He expects that all his patients will do exactly what he says regardless of whether it’s practically possible, and seems astounded and offended when they don’t. He exudes medicine in all it’s paternalistic glory.
Of course because it’s a TV show Doc has endearing qualities, like his cute crush on the local school teacher. And of course because it’s fantasy Doc seems to have no pesky reality issues like billing codes and insurance companies (except for the disastrous secretary). But you keep watching because despite his manner, he clearly cares about the members of the community. He is always immediately available. He gets to know all the people in the town despite himself, because they are all so nosy. Whenever someone goes to the hospital, whether he sends them there or they go because of an emergency, he goes too, speaking to specialists, examining the patient, following the case. That’s why in the end his curmudgeonly ways don’t matter. People sense that he cares. Plus the show is really funny.
Part of the learning curve for Doc Martin as he becomes this GP is starting to recognize the human elements behind diseases. A woman with a son who has a contagious skin condition sends her kid to school even though Doc says not to because she works and has no one to take him. A kid who is too smart for the local school ends up staying with Doc after his destitute mother gets burned by a fish fryer. The overweight plumber who eats because his only son wants to become a computer programmer instead of joining the business. Announcing on the radio that the town water was not drinkable without knowing the damage done by a similar episode in the past. We see the doctor start to realize that disease processes do not usually occur in a vacuum. There’s a person and a circumstance behind each symptom.
No one is suggesting that we return to extreme paternalism in medicine, nor do any of us want a doctor who tells us to shut up, but I think sometimes we yearn for the time when our doctor knew us personally, and our families, and our circumstances, and we saw him/her at church or at the grocery store. When the doctor saw us in the hospital or made a house call if necessary. I think patients yearn for it, and I think doctors do too. Those days are over but we try to hold on to a little bit of humanity whenever we can.