Give Me Some of that Old Time Medicine –

Richard T. Scholz, M.D.

President

One of the privileges of having lived many decades is the right to reminisce or “geeze” about the way life used to be in our profession. 

When I was growing up in Baltimore during the 1950‘s and 60’s most physicians and virtually all specialists were downtown.  My father was an ophthalmologist, which at the time was not a very well represented specialty.  Optometry did not have nearly the presence that it does today, so many people who sought eye care of any sort saw an ophthalmologist.  Individuals would travel from all parts of the state and neighboring states to see my father.  He maintained a satellite office in Towson on the second floor of an old house on Washington Avenue, but in a reversal of today’s migration to the suburbs, closed it because everyone was willing to travel downtown.   

I recall that 30 years ago, a medical school classmate of mine spoke derisively of “beltway” doctors, those physicians who had multiple offices, the thought being that a quality physician would only need one location as patients would travel any distance to see anyone who was a superior practitioner.  In 2011, many of the most prominent specialists and sub-specialists in Baltimore County have multiple office locations. My father’s Washington Avenue location is now the site of Baltimore County government offices.   

I remember going on rounds with him to St. Joseph Hospital on Caroline Street, near Johns Hopkins.  It was torn down for a school and now is a vacant lot.  South Baltimore General Hospital (now Harbor Hospital Center) was another stop on rounds and was on South Light Street in the Federal Hill area.   

I suppose some government regulation benefits patients. I remember that instruments used for minor procedures in my father’s office were sterilized in what was essentially a toaster oven and were certainly not kept in sterile packaging.  Being on-call and availability was another issue. Apparently, it is now mandated that there be some form of coverage available as a condition of licensure, although this can be the answering machine instructing you to go to the emergency room.  If the office was closed and the doctor was not at home, you were out of luck.  At least this was true for specialists.  When I was a resident from 1980-1983, you simply assumed that sub-specialty care may not be available on weekends or available with any reliable regularity. 

I visited two past presidents of the BCMA, Ted Patterson (1967) and Bill Reichel (1976) and asked them about their practice experiences during the 1960’s and 1970’s.   Both of them felt that they had very close relationships with their patients.   

Dr. Patterson lived and worked in the same community that he grew up in and his patients were people that he would run into in the grocery store and who did not hesitate to call him at home with problems.  On nights or weekends they might call with problems or even come by his house to be seen.  Such a close relationship allowed the exercise of judgment in dealing with afterhours emergencies – knowing if a patient’s concerns were something that needed to be addressed immediately or could wait until the morning.  Patients no longer assume that they can speak to their physicians after hours.  I told him that my patients often seem astounded when I tell them that my home phone number is in the white pages and that my partner and I are available by beeper 24/7.   

Patients now call 911 or wait for hours at emergency rooms in the middle of the night for problems that could easily have been seen in the office the next day.  (I remember seeing the card of a very prominent ophthalmologist and on it following the office number was the number for his “residence” - he has long since retired).  He made rounds when his patients were admitted and discussed how he would sit on the edge of the bed so that he would see eye to eye with the patient and what a comfort it was to the patient. (An office visit was $5.00 and a house call was $10.00)  

Increasing demands on the primary care practitioner’s time and the rise of the hospitalist has led to the elimination of “rounds” on one’s own patients.  Dr. Patterson felt that the loss of the direct fee for service system and the rise of insurance plans has caused a further rift in the doctor patient relationship as patients feel entitled to care and in some instances want to direct the care that they receive.  A patient in our practice had a procedure performed and was upset that he received a bill from his insurance company for a deductable that he had not met – he complained to the Board of Physicians about this, feeling that it was the physician’s responsibility to inform him of this ahead of time - something of which the physician would ordinarily have no knowledge.   

Dr. Patterson also recalls the camaraderie and collegiality that was engendered by the Medical Association and its meetings.  One would socialize with the specialists to whom one referred patients and also with colleagues in the same specialty. Such interactions would keep one up to date on practice patterns and community standards of care. 

Dr. Reichel was an internist working in gerontology research at the gerontology branch of NIH which is on the campus of Bayview when the new Franklin Square Hospital opened (replacing the old hospital at the corner of West Fayette and Calhoun streets in Baltimore City). Dr. Reichel left NIH to take on the mission of establishing the new department of family medicine at FSH.  He built a successful and prominent program while continuing his interest in gerontology.  Dr. Reichel’s Care of the Elderly is now in its sixth edition (2009) and he tells me there is talk of a seventh! 

He recalls how close he was to his patients – he told the story of a patient who died in his wife’s lap one night and she waited until the morning to call him and inform him of the death because she did not want to disturb him at home.  He, too, feels that the rise of corporate medicine and HMO’s has driven a wedge between doctors and patients and is strongly in favor of a single payer system.  

So some things are better (autoclaves and beepers) and others worse.  The practice environment is hindered by the morass of payment systems that limit patient choice and may limit physician participation.  I like to think that we can overcome this in the way that we care for individual patients, and that nothing can stand between us.