HEALTH CARE-LOOKING BACK

As many know there was a massive FIOS failure last night sometime before 9pm; resulting in no telephone, TV, or Internet. About 9:45 am TV and Internet returned. The phone is still out. (9:50 AM).

It has been a generation since I last treated a patient. The changes in health care in that time have had a depressing impact on me. I am not referring to the modalities or techniques available but rather how they are implemented.

I was taught that a good physician had to do the following; Talk and listen, palpate, percuss and auscultate in order to make a diagnosis, or to follow up. With my trusty stethoscope I could even diagnose tuberculosis in the lung’s upper lobes where it usually started. Pneumonia and the affected portion of the lung was an easy diagnosis that could be confirmed by x-ray if desired.

A complete physical took more than 10 minutes since among the routine check of the pulse and blood pressure one also checked the ears, eyes including using the ophthalmoscope, the mouth, the neck both listening to the carotid arteries and checking the thyroid gland and feeling for lymph nodes visual exam of the chest and abdomen plus front and back. Then there was auscultation of all quarters of the chest including percussion of the lungs which could be very informative, as well as the heart for murmurs and rhythm abnormalities. We believed that to be effective this had to be done on the skin.

The abdomen was checked by palpation and again listening to the bowl sounds. The legs were checked including feeling for the pulses in the groin knee and feet. This included all the reflexes including the Babinski. 

With the annual physical of a male there was included that dreaded rectal exam which would check the prostate and sometimes find an asymptomatic early rectal cancer. Women did not get of scot free; they had a pelvic examine addition to the rectal. The cervix was visually examined and once the Pap smear became on the scene one was sent to the lab. The uterus and the area around were checked by palpation. Of course the office nurse was always present in the room as a protection for both the patient and the doctor.

Compare that to the so called complete physical most patients receive today. This I will mention in a later blog.

 For 45 years that was the basis of my practice and of my peers. Our patients felt we were their friend and could confide in us. At times we were forced to substitute for a confessor. Always there was a personal relationship which some survivors have maintained to this day. If you cared and enjoyed people you became a primary care physician either a GP or an internist.  Most who had trouble relating to people became Surgeons.

I will note that we were available 24/7 and I made house calls from Middlesex to Scotch Plains, from Warren to Piscataway/Edison. I even had patients come from as far away as Sparta.

This however is not what I set out to write; I am going to comment on my opinion about the effects of Obama care. At the same time I may have to interject some anecdotes or history of the changes that have taken place and the reason they have done so. That will also mean that I may have to devote a blog to answer questions. I will warn you that my answers may not be the popular one.