What happened to "old school" medicine?

Times they are a-changing.  My dad wouldn’t have liked what’s happening. C. A. Hoffman, Jr.  was an old-school physician.  Often, to the chagrin of his office staff, he spent real time with his patients.  Five o’clock would come and go. His office was busy and filled with his laughter and booming voice.  A ringing office phone made him happy.  There was a blackboard in his office.  It had to be white with chalk, covered with his “To Do” list.

When I visited the office, I would sit on a strange-looking metal safe and watch him as he went from room to room.   That safe was so heavy that no one could move it.  It just sat for years in the middle of the busy office front, taking up space and getting in the way. Dad had an answering service to take calls after hours.  The service would call our house in the middle of the night and on holidays. No matter when, he would return his patient’s calls and order prescriptions for them.  If it was an emergency he would direct them to the Emergency Room of the hospital.  Then he would get up and meet them there.
He worried about his patients.  If he lost a patient, I would know about it because he would be incredibly sad.When he died, there was a line of people that wound around the funeral home, waiting to speak to my family.  I don’t know how many hands I shook that night or how many times I heard, “your father saved my child” or “if it hadn’t been for your father, I wouldn’t be here today.” After he died, my family opened up that safe.  There were thousands of invoices that he had just slipped into the safe and forgotten.  Many, many of his patients received his care for free. My father is not the only physician I have known to do this.  My pediatrician was another.  He did not die a rich man, but he was dearly loved. Now when I go to the doctor’s office, I’m expected to pay at least the copay, before receiving care.  If I couldn’t pay, would I get to speak to the MD?  No; I would have to explain my financial situation to someone at the front desk in front of the other patients.  Probably, I wouldn’t get to see the physician. When I call the doctor’s office after hours, an answering service takes the call.  My call is directed to a nurse on call who is looking at my records on line.  S/he doesn’t know me.  If it is an emergency, I’m sent to the Urgent Care Center.  I don’t see my physician.My father opposed universal health insurance, calling it “socialized medicine.”  But I wonder what he would say if he saw medicine as it is practiced today.Many say the change in medicine is due to the terrible financial burden most medical students incur to become physicians.  I’m afraid I don’t see it that way.  I believe that medicine has become a business and generosity has no substantial place in the business paradigm. Nowadays, I believe we need universal health coverage because there are so few “old school” physicians left.  They are a dying breed.


5 thoughts on “What happened to "old school" medicine?”

  1. Hi Kathleen,
    I’m an old-school kind of doctor, although I no longer practice. I support a single payer system because that’s the only way all patients will be treated with equal dignity and attention by physicians. Also, if we could eliminate the huge fraction of health care dollars that go toward insurance administration and company profits, there’d be more dollars in the system for doctors to be paid for intellectual work and thoughtful care, and more money to cover the costs of needed treatments.

  2. Kathleen,
    First of all, you need to know that my father so resembled yours that he too was named C.A. Hoffman, and he, too practiced a style of medicine that would not be recognized by most of today’s young physicians. His three sons became doctors, which speaks loudly for his positive influence on our lives. I’ve recently retired from an Infectious Disease practice in western Massachusetts, but remain active as an educator and infection control specialist. I agree with your view that medicine should not merely be a way to earn a living. It is so much more than a job- it is a way of life that was once described proudly as a “profession.” Now comes the hard question to answer- how do we reverse the process other than to try to roll back the entire 21st century? Can market forces lead to a change by finding a reasonably priced humanistic model for medical care, or has corporate medicine become so pervasive that the market alone cannot be relied upon to allow change to take place? How will new practitioners learn that there’s a better way if no one teaches it in the institutions that teach our brightest young people? I’m an “old doc”, but I’m still a teacher, and I’m getting tired of constantly trying to sail into the wind and against the tide.
    Robert Hoffman M.D.
    Distinguished Professor of the Health Sciences
    Bay Path College
    Longmeadow, MA

  3. Robert,
    I am so grateful to read your comment…Glad to meet you here in cyberspace…There is a a better way…as we both have experienced. I am thrilled to know that you are teaching that better way, teaching physicians-to-be that there is more to being an MD than the “business” model. I take great comfort in knowing that there are still “old doc’s” teaching and making a difference…and though you are growing weary, please know that you are making a difference! Dad took on a young, just out of his residency, physician as a partner before he died and he worked with him, providing an example. I am pleased to report that patients that go his protege talk about how the young doctor is like my dad. He learned that medicine is not just “a way to make a living” but a “way of life.” Thank you so much for reading this post and responding! And thank you for being an example and teaching the “profession” of medicine! You honor your father’s memory and help more people than you can imagine!

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