I learned a lot from readers responding to last weekend's column — an ode to my beloved doctor, who opted to retire rather than wrestle with forces turning the art of medicine into the science of numbers.
I won't find another Marcus Welby clone, they warned. The hand-holding primary care physician is virtually out of reach, unless you're very lucky or moderately rich.
Electronic medical record-keeping has promise but is plagued with problems. Collecting the data that can help control costs and track patient care has been such a cumbersome process that it's chasing good doctors from careers they love.
And I'm not the only patient with an outsized attachment to a doctor. Many of us care less about Yelp reviews and Ivy League diplomas than finding someone we trust to care for and about us.
I got an email from a 72-year-old man who flies back to California from his new home in Chile every year for a physical from the Del Mar doctor he's been seeing since 1981.
Another reader told me he doesn't mind making the two-hour drive from Ventura to Long Beach for an appointment with his doctor "because he knows everything about me, and we just like talking golf and hiking."
I heard from a woman visiting from Hawaii so her husband can have his cataracts removed by his Santa Monica ophthalmologist. "Even after relocating 15 years ago, we return every year so that he can consult with his trusted physician," Leburta Chock Kanno wrote.
Both of them have been through the draining process of trying to find new physicians. "We need the doctor who holds our hands and admonishes us to exercise, who treats our ailments with compassion, and sees us through our adversities," she said.
"Our hope is that new healthcare models will not drive the family doctor into oblivion."
I've been hoping the same thing, but the prospects don't look good.
I heard from dozens of frustrated physicians who say they can no longer afford the relationship-building. They're scolded by insurance companies when they bill for visits that run long and docked by the feds if they don't enroll in data-collection programs that aim to quantify the quality of medical treatment.
The doctors I heard from echoed what national studies suggest: It can take the equivalent of a full workday each week to keep up with the electronic "paperwork" demands of a metrics-driven system that doesn't seem to reflect the needs of the patients they see — the elderly woman who needs everything explained more than once, the frightened parents trying to understand treatment options for an ill child, the overweight man who began to exercise only because his doctor persuaded him to try hiking.
The American Medical Assn. wants a "design overhaul" of the electronic health records system. The fact is, our entire medical system is in the midst of an overhaul — one that will expand healthcare access for millions of Americans but may also alter the traditional relationship between patient and doctor.
Some of the work of family practice is being parceled out. Staff physicians called hospitalists now make the rounds of hospital patients so family doctors don't have to make those visits.Nurse practitioners and physician assistants have taken on some routine care in family practice visits. We can get vaccinated at the local pharmacy and have a nagging cough checked out at an urgent care clinic.
Some doctors are resigned to giving up their autonomy. They sell their practices to hospitals or university health systems and become salaried employees. "All the stresses of rent, malpractice, billing and personnel problems are gone," said Dr. Michael L. Friedman, an obstetrician and gynecologist who signed on with UCLA after 40 years on his own.
Others are shaking off the burden of massive client rolls by limiting their patients to those willing to pay extra for their services. In his Torrance concierge family practice, Thomas W. LaGrelius offers 30-minute visits, on-time appointments and personal consultations "24/7/365" to 600 patients who pay annual membership fees of $1,050 to $2,100.
"Running on the discount-insurance based hamster wheel is fatally destructive to doctor morale, patient care and the entire health system," LaGrelius said.
And the only way for me to find a doctor like the one I lost to retirement, he said, "is to join one of us."
I can't afford a concierge doctor, and I don't think I'd join if I could. I believe everyone's entitled to that kind of attention — and I was gratified to hear from so many doctors determined to provide that in a system that seems tilted against it.
"Listening to patients, knowing their history, family, past and personal struggles are all woven into good medical care," wrote Lompoc family practice physician Cory Gusland. "It takes extra time, it is not rewarded financially."
But it is inestimably important, he said. Science bears that out.
People who feel satisfied with their doctors — and much of that rests on interpersonal and communication skills — are likely to have better health outcomes when they face illness or disease.
Doctors seem to feel pressured to order tests rather than give patients the time to talk about their problems. On average, patients get about 18 seconds to describe their symptoms before doctors interrupt.
That would explain the complaints I heard about doctors who don't seem interested in conducting an exam or even making eye contact.
"They come in the room to see me, but basically interact with their computer screens for almost the entire time," said Mary Carlson of Mission Viejo, who, like me, lost her longtime doctor and has been auditioning replacements. "It pains me to think that is what our medical system has come to, and I find it to be pretty compassionless care."
I'm with you on that, Mary. Making a personal connection is the first step to good patient care.