Declining Professionalism in Healthcare or What Happened to All the Good Magazines?

 It dawned on me. I was an adult. Here I was sitting in the lobby of a medical office without my mother.  At age sixteen I had driven myself to the appointment. There was no pageantry, no ceremony, and no announcements or gifts. Adulthood just happened.  It came about in the most unceremonious way:  My first physical examination by an internal medicine doctor, not a pediatrician. I think that’s why I remember it so well. It’s like a slow motion movie in my head.  Is my memory correct?  The movie in my head seems idealized, like an episode of Marcus Welby, MD. I had been apprehensive about going.  My brothers had warned me of the gloved examination ahead of me. Or should I say “behind” me?  And the Internist’s name was Doctor Payne! (I heard Pain)

But the apprehension was fading fast. The Lady at the front counter had been really nice. She had noted that I was a Franklin. She had talked about my family and how much she liked my parents. She smiled as she talked. It was a comfortable place to be. I sat on the cushy sofa and looked at Yachting magazines. 

It wasn’t long before a friendly Nurse called my name.

My first name. 

She had me weigh in and then took me immediately back to a patient room.  She chatted away about how many years my family had been coming to see Dr. Payne and reminisced about when my mother had worked there as a Medical Assistant. After taking my vitals and a vial of blood she said that Dr. Payne would be just a minute.  I barely had time to get changed into the exam robe before he knocked on the door.

After a thorough exam, Dr. Payne said that I should get dressed and then come down the hall to his office. I did as I was told.  When I peered into his office he was sitting back, relaxed and smiling.  He said, “Sit, please have a seat” motioning to the chair in front of his desk.  We looked across the desk at each other. He was clearly sitting in the seat of authority, but I was seated directly across from him. Equal as a man.  And then we had a conversation.  He asked me what I liked to do.  Was I going to be a photographer like my Dad? He told me that he liked to fish. He asked if I was dating. He seemed… no… he was genuinely interested.  The Nurse knocked at the door and leaned in and handed him some paperwork.  Dr. Payne looked it over and then looked at me. He said, “Your blood sugar is really high, did you follow the fasting instructions we sent you?” I nodded and he rubbed his chin. Then I said, “Well, I did get thirsty and I drank a Mountain Dew on my way up here.” His face relaxed into a smile, “Well, that would explain that.” He stood up and said that everything else looked good. He said he would see me next year and held out his hand to shake mine.  I stood and gave a firm shake like dad had taught me.

And I was on my way.

This pattern repeated itself year after year. Always the trip back to his office to wait on blood results. I remembered not to drink a soda until after the appointment. There was always the same friendly staff and nice conversations. Plenty of yachting magazines to peruse. And each visit ended with a firm handshake. Shortly after I finished college, Dr. Payne retired. He told my family about a young Doctor who had just joined the practice. He said that he had all the latest education and was a nice guy to boot.  You see, in those days, the nice guy part was just as important as the latest education part.

The new Doctor practiced the same kind of medicine as Dr. Payne.  He was young, but everything else stayed the same. Dr. Marshall took his time and patiently listened to my questions.  We had great conversations year after year.  The staff would change from time to time, but were always nice.  The office had Life magazines, Time Magazines, and Boating magazines.  The occasional Yachting magazines with turned up corners were still in the mix as well. And each visit ended with a man to man chat in the Doctor’s private office followed by a firm handshake.

  One day an announcement arrived in the mail.  

 I hardly payed attention to it, but apparently the practice that Dr. Payne and now Dr. Marshall worked for had been sold to the hospital. 

It said nothing else would change, so I chunked it in the trash and forgot about it.  Were things different at my next appointment?  I can’t say. I just can’t remember.  It was at the least so similar that it didn’t matter enough to stick in my brain.

  Except…that maybe the lady at the counter had been just a little less friendly….  I’m not sure… but I don’t think she knew who my family was. And maybe… just maybe… the Yachting magazines had been hauled away.

Soon the Life magazines and the Time magazines gave way to celebrity rags like People and Us.  I’d have to go on an archeological dig to find a Boating magazine.  The counter staff had grown to two or three ladies.  They were happy enough chatting with each other, but seemed slightly put out when they had to check a patient in.  The Nurse was stern. All business, no chit-chat. She called out my name. My last name. 

The respite would come when Dr. Marshall would make his casual entrance, lean against the counter, smile and ask questions. He asked about my family and my work. But at some point I noticed that the conversations were no longer two-way.  If I started to go into much detail about a non-medical issue he would get antsy. The private office visits had stopped. But at the end of the exam he would give a nice firm handshake.

As each year passed it seemed like the visits were getting shorter and shorter. I often found myself leaving, on the elevator, when I would remember something that I had meant to ask him.  He was the same Dr. Marshall, always pleasant, but now he seemed distracted. He would even forget to do the dreaded gloved examination sometimes.  On one of my last visits to him, I swear that he kept one hand on the door knob the whole time, including while he listened to my heart. 

He was being rushed!  How could this happen?  He was a Doctor!  Who could be more important than a Doctor?  Who could be making him feel the need to race to the next patient?  I was confused. And dammit, the Boating magazines were gone too.

And that’s when it ended.  After the boating magazines left, so did Dr. Marshall.  When he retired, he seemed too tired to even make a wholehearted recommendation of any other Doctor on the staff. Now I know why.

I randomly picked a new Doctor. I wanted someone young. Someone who could be my physician for the rest of my life. 

The office had been completely remodeled, sanitized even.  The men and women at the counter were no longer happy at all.  They didn’t chat it up with each other.  They barely made eye contact with the patients as they checked in.  They made us show our insurance card at every visit.  They made us scan our palms. The nurses were different at every visit. 

They would call my name. Last name, First name. 

The nurse had stopped drawing blood long before.  They had a lab.  Apparently having a lab meant that instead of getting the results at your appointment you could look them up a week later, on the patient portal, if you could remember your password.

The Doctor did not have a private office.  He had a cart in the hallway.  There was no time for pleasant conversation.  All the questions were designed for efficiency.  The visits were quick and procedural.  He never forgot the dreaded glove exam.  The waiting area had institutional style chairs.   And wait we did.  

Someone had decided that patients should not look at magazines while they waited.

Long waits with the only thing to read being slick brochures about cancer and diabetes. 

Apparently Doctors no longer had the time to boat, let alone yacht.

This place that had been so comfortable.  This place where my adulthood had dawned had been wiped clean. It had been transformed. It had vanished. 

And I can’t remember the last time a Doctor ended the visit with a good firm handshake.