Goodbye to a trusted doctor, hello to the healthcare wilderness
I’ve been lucky for the last 20 years. I could listen silently while friends complained about their medical care. My doctor was never too busy or too brusque. He always made time to listen. I never had to pay concierge fees for what I knew was uncommonly good and thorough care.
But my luck ran out last summer when my doctor unexpectedly retired — pushed by some of the forces that are supposed to make patient care better and more accessible for the masses.
He was working harder, earning less, frustrated by bureaucratic demands and feeling the weight of his own advancing age. The day he hesitated when writing a prescription because he couldn’t recall the name of a familiar drug, he began thinking it might be time to move on.
His lapse lasted just seconds and probably wouldn’t have troubled his patients. I’d have drawn comfort from the fact that, at 65, he’s experiencing the same senior moments that I fret about.
Now my daughters are trying to console me. Maybe it’s time, they say, to find a young doctor, one who’s up on the latest research and armed with high-tech tools.
I prefer the experience of someone who doesn’t have to consult an iPhone app to figure out what my symptoms mean. A doctor who will return my panicked phone call and assure me that my middle-of-the-night vertigo is probably fleeting and benign and the black spots fluttering through my field of vision don’t mean that I’m going blind.
I intended to grow old with my health in the capable hands of a man I’d learned to trust. Instead I’m joining hordes of patients in California stranded by healthcare shake-ups and a looming doctor shortage.
The pool of internists and family practice physicians — the doctors we see for physicals and ordinary ailments — is shrinking faster than it can be replenished. Only about 20% of medical students in this country go into primary care. Most gravitate instead toward specialties that demand less and pay more.
Primary care doctors are supposed to be the linchpins of the Affordable Care system: They’ll track our health, head off problems, school us on prevention and coordinate whatever specialist care we need. But a recent study of healthcare in California found that only 16 of the state’s 58 counties had enough primary care physicians to meet residents’ medical needs.
Those doctors are bearing the brunt of the system’s growing pains. Their expenses are multiplying, their revenue shrinking and they feel burdened by government mandates and insurance company demands.
They’re the pioneers in our national shift from paper patient files to electronic medical records — a skills challenge in a field where almost 30% of the physicians are nearing retirement age.
Many complain that cumbersome record-keeping cuts into time they used to spend talking with patients. It can take hours each week to transcribe notes, check the right boxes and click through online drop-down menus for the proper codes for every treatment and diagnosis.
That too influenced my doctor to hang up his stethoscope. He chose internal medicine because he wanted to build relationships with patients; to look at us and listen, not tap away on a keyboard while we talked.
On my final visit I asked my doctor if I could check in with him to see how retirement’s going. We met for lunch in Pasadena this week.
He looked happy and well-rested. He’s traveled to Spain with his wife, become an active member of her church and joined a tournament bridge club that meets twice a week.
Still, he misses his patients, he said; he’d been tending some for almost 40 years. We talked about the stresses of his profession: the middle-of-the-night calls, the failed treatments, the intractable illnesses. He never got accustomed to letting go, to watching patients he’d grown close to wither and die.
I wanted to tell him how much I’d appreciated him; how much he’d taught me over the years about taking care of myself. But I felt suddenly awkward, talking to him as Glenn, instead of as my doctor.
That didn’t matter because what he wanted to talk about was how much his patients had taught him:
From the woman in her 90s, stressing about a son who was 72, he learned that parents never stop worrying about their children.
From the patients clinging to hope through devastating terminal illnesses, he realized that for all our talk of dying with dignity, no one is really ever ready to go.
From the family marking a matriarch’s demise with a joyful “home-going” celebration in her hospital room, he was introduced to the sustaining joy and power of faith.
Watching his patients grow old taught him to appreciate the natural aging process that is bound to hobble and humble us all. “Most of my older patients, no matter the obstacles, were still optimistic, still enjoying life,” he said.
They were his teachers, and he became mine.
I remember our first visit in 1994. I was newly widowed and my youngest child was a toddler. Your job, I told him then, is to keep me alive for 18 years, until all three of my children are grown.
I realize now that he must have sensed the fear beneath my banter. But he never pitied or patronized me.
He understood I was more than a collection of ailments or a data set of test results. He let me ramble, cry, complain. He advised, but didn’t judge. His most frequent prescription was “exercise,” no matter what the problem.
And what I’m most grateful for has nothing to do with high bone density or lowered cholesterol. He made me feel less like a patient and more like a partner.
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