How the Practice of Medicine Has Changed


This article comes from the Physician Practice by Lucien Roberts.  It was so nice to read about the “authentic” doctors that I have to reprint it here:

Once, there was a time when healthcare was led by physicians rather than by acronyms; HMOs, RACs, ACOs. What a difference a few decades can make! My dad, who was a practicing OB/GYN for 37 years, is a good illustration of the many ways that medicine has reinvented itself. Here are a few of the many hats that dad wore as a small-town physician:

My dad, the cab driver. Dad was both surgeon and anesthesiologist when Miss Darlington, the CRNA, came to South Boston. She couldn’t drive, so she made daily taxi rides to work. If my dad needed her assistance at night, or during the weekend, he added “Pick up Miss Darlington” to the pre-surgery checklist. Taking her home was part of the standard post-op care.

My dad, the blood bank. There was no blood bank, just a simple list. This list had phone numbers for all the folks in the community who could be counted on to drop whatever they were doing, to give a pint of blood to someone in need. There was never a blood shortage. Several years later, my mother and others on the list helped establish the county’s own bloodmobile, which still serves my hometown to this day.

My dad, the builder.  Remember the black countertops from the high-school science labs of the ’60s? Plywood was treated with an odd epoxy resin to create a modern-day petrified wood. Dad and his partners used this same formula for the countertops in their lab. Whatever the secret sauce was, it really worked; those counters lasted more than 50 years, never showing signs of splintering, warping, or other degradation.

My dad, the barterer. Miss Moore was a wonderful lady who raised pigs out in the country. Every Christmas we’d go out to her farm and she’d give dad a cured country ham — far and away the best ham I have ever had. That’s how Miss Moore paid dad. For those patients who could not afford to pay, bartering was a common way to say thank you.

My dad, the football VIP.  Before cell phones and pagers, being on call meant staying at home or being at the hospital. There was one exception: high school football games. The on-call doctors got front-row parking in the gravel lot. If a patient came to the hospital in labor or with appendicitis, the police were dispatched to the game to get my dad or the surgeon. I knew my dad was well-respected, but his special parking was how I knew he was important.

My dad, the ER doctor.  During dad’s first decade in private practice, there were no emergency room physicians. Every doctor in town, including my dad, was part of the emergency room rotation. With dad doing that and being on call every other day and night, I still wonder when he and mom found time to make my three brothers and me.

The art and practice of “medicine” has changed remarkably, yet the core tenet of medicine — caring for patients — remains what doctors do best. It’s what my dad did so well, and it’s what you do best, when the acronyms stay out of the way.

Lucien W. Roberts, III, MHA, FACMPE, is a Virginia-based writer, speaker, and consultant. 

Douglas Farrago MD

Douglas Farrago MD is a full-time practicing family doc in Forest, Va. He started Forest Direct Primary Care where he takes no insurance and bills patients a monthly fee. He is board certified in the specialty of Family Practice. He is the inventor of a product called the Knee Saver which is currently in the Baseball Hall of Fame. The Knee Saver and its knock-offs are worn by many major league baseball catchers. He is also the inventor of the CryoHelmet used by athletes for head injuries as well as migraine sufferers. Dr. Farrago is the author of four books, two of which are the top two most popular DPC books. From 2001 – 2011, Dr. Farrago was the editor and creator of the Placebo Journal which ran for 10 full years. Described as the Mad Magazine for doctors, he and the Placebo Journal were featured in the Washington Post, US News and World Report, the AP, and the NY Times. Dr. Farrago is also the editor of the blog Authentic Medicine which was born out of concern about where the direction of healthcare is heading and the belief that the wrong people are in charge. This blog has been going daily for more than 15 years Article about Dr. Farrago in Doximity Email Dr. Farrago – [email protected] 

  8 comments for “How the Practice of Medicine Has Changed

  1. Vance
    November 29, 2013 at 7:34 pm

    Docs like that DO still exist, just not in urban areas. How do I know? I AM one.

    A rural Family Physician, I share call in a busy ER 24/7/365 with 3 other docs. We do the inpatient, outpatient, and OB care, womb to tomb, for our community. I also wonder how my kids ever got made. I think we’re just really fertile, because there have been precious few times to go about such an endeavor.

    Lucien, you mentioned that your Dad got front row parking at High School football games. My partners and I share “sports med” call for our state champion team, and at least one of us is always on the sideline for the games. And get this: we get to park ON the field for the quick emergency get-aways! yes, just inside the fence, beyond the North bleachers, sets one or two ambulances, and one or two of the Doctors’ cars.

    Real full-spectrum, highly-respected medicine is still practiced in our country.

    Now for the political side of this discussion. Corrupt insurance companies and an even more corrupt power-hungry government are definitely making it hard to do this work. The solution is a Direct Medical Access model (which is the way it used to be anyway) coupled with catastrophic insurance plans for those who don’t have insurance through work or medicare, coupled with Health Savings Accounts where possible. It works, it can be affordable for everybody, it saves everybody money, it largely increases job satisfaction for doctors and is loved by patients. It gives unprecedented access to care, and it cuts out the parasites of medicine.

    However, it does demand a fair amount of personal responsibility, something this country quit demanding way too long ago. But out here, personal responsibility is the norm.

    • Doug Farrago
      November 29, 2013 at 8:21 pm


  2. Pat
    November 29, 2013 at 1:50 pm

    Great piece. I have some similar memories of growing up the son of an ‘old school’ doc. But once people thought the had an unaccountable “right” to the work and caring of me like ADR. Roberts, those days were over.

  3. Scott Miller
    November 27, 2013 at 4:20 pm

    I wish, Lucian, I wish that things could go back to those days! Your father probably enjoyed what he did, but how many of us health care providers (I’m an MD) do today? We have to work harder and harder not for the love of the profession, but to support administrators, lawyers, and insurance companies.

    Hate or love Obama, at least the guy tried to make healthcare more available. Yes, “Obamacare” is a mess, but have the insurance companies done better? More efficient, yes, but only for more profit and that means more dollars for them and fewer for the patients and providers. Bucks are everything to them, but should they be for us?

    Physicians screwed up when they turned over administration to the business types. It was a deal with the devil that has made medical practice harder and harder. Now we are only employees, just commodities like grain and wheat.

    I hate to say it, but maybe now is the time for medical providers, all medical providers, to organize into a collective group. Not AMA fat cat stuff, but a real union. But the MDs and DOs will have to accept the PAs and NPs on equal terms as human beings or the thing will fall apart.

    I don’t expect this to happen.

    Scott Miller MD

    • Steven Gilles
      December 4, 2013 at 2:25 pm

      Dr. Miller,

      I’m glad you made this comment. As you noted so very truly, MDs and DOs will need to accept PA/NP providers as human beings before we could form a cohesive group to try to bring rationality back into the practice of medicine.

      Sadly, many of the readers here and our dear author Dr. Farrago feel that PA/NPs are a symptom of the problems that exist within medicine.

      So, the PAs, NPs are faced with distaste from MD/DO leadership groups and from a few practicing physicians (not all – I work with excellent physicians). The end result of this pervasive attitude is angry NPs that want independent practice and frustrated PAs that simply ask to be respected for showing up and instead are told we are trying to take physician jobs and to just be quiet.

      Thank you Dr. Miller.

      Steve. PA-C

      • Doug Farrago
        December 4, 2013 at 2:49 pm

        Once NPs (and rarely, some Pas) felt the need to compete with doctors then they became of problem. No one said you weren’t human, that you weren’t smart, that you didn’t work hard, etc. That is your bias and tainted glasses reading into that. Your comment of “the end result of this pervasive attitude is angry NPs that want independent practice” is absolute 100% horseshit. It is just the other way around. Their need to compete with us and claim that they are as good as doctors (meaning that training and education is useless) is what brought out my defensive posture. AND I AM PROUD OF IT!!!!

  4. Mary
    November 27, 2013 at 2:24 pm

    Could not agree more. Medicine is run by the bean counters. After 46 and a half years as an RN I retired. Glad to be out.

  5. Lynne Luckett
    November 27, 2013 at 10:52 am

    What a well written and loving tribute to your dad. Great way to start my day! Thank you!

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