Years ago, my parents' doctor, the doctor who delivered me and my brothers and sister and the pediatrician who take care of us, were almost friends of the family. They, and their staffs, knew much more about our family then just medical issues because they took the time to talk with us (or at least my parents). That is something that has faded over the years. The first sign was when our pediatrician, who had an arrangement with another pediatrician in the neighborhood to cover for each other during vacations, joined a practice with that pediatrician and a third. At first, it wasn't a big change as the two older pediatricians kept their offices and the third pediatrician circulated among the two offices. Except the third pediatrician didn't know who we were and it felt strange to be examined by a stranger (as a side note, I saw her again 20 years later in her side gig as a mohel -- she was very nice and made sure all parties were comfortable, which, considering what she was doing, was pretty important).
As the years went by, the doctors who treated our family retired and we were forced to find new ones. As my mother's health deteriorated (my dad has long since passed) her doctors became the various specialists associated with old age. However mine, and wife's, were still the general internists that treated our parents. However, our experiences were so much different. Our first doctor was so busy that, when you were sick, by time you could get an appointment, you were either healthy or in the ER. It seemed he spent more time entering our information into his computer (at the time very modern) then he did checking us out. With a new health plan at work, we soon had a new practice to go to. Our second doctor, who we loved, was a little more old fashioned and would actually spend time talking to us (I still remember one time, while he was supposed to be examining me, a piece of artwork he ordered arrived and we spent several minutes discussing it).
When I mentioned to my mother that he reminded me of her and dad's old doctor she sighed and wished more doctors were like that. When I asked why she said that when the doctor actually talked with and listened to her she gave more information. It wasn't that she was deliberately withholding information, it was just that it didn't come to mind until they were chatting. She swore that he provided her with better care because of this. After we hung up I thought about it and realized that while we were chatting I asked him about something else I had forgotten about and it changed the course of the exam.
Today, I go to a sole practitioner who, while competent and has a very good staff, is so busy he barely has time to know who I am. I need to come in armed and ready with what is ailing me, sometimes with a list of questions, mostly so I don't forget because I know if I do, it will be a little while until I can ask him. Not his fault, it is the nature of modern health care. You see, he has been a practitioner in my area for decades (an older family member of my wife's recommended him) and now has, from looking around the waiting room, a large elderly cliental, a number of whom, I assume, are on Medicare. Considering the lower fees Medicare and insurance companies are paying these days, it is obvious he needs to take extra patients to make ends meet.
What reminded me of all this was an article in the NY Times a few weeks ago about insurers paying physicians to devote more time to their patients, in the hope that they will be able to scale back costly treatments later. I thought of what my mom said all those years ago, especially as I saw yet another pediatrician from our children's practice who didn't know us that well, though we've been patients since before our 4 year old was even born, and wondered just how much we are messing ourselves up today.
While I still trust my doctor to do what is right, I like to verify, at least as to the basics. He's overworked, I'm overworked -- mistakes happen. Not a problem unless the mistake is a serious health issue not caught. Preventive care doesn't pay as well as actual care, at least long term, for insurers and doctors who may not be caring for the patient by time the benefits are realized. This can not end well.
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