Knights in White Coats

In “Just Playing Doctor” (Annals of Internal Medicine, March 17 2009) an article by David Alex Stroh, a medical student at Johns Hopkins School of Medicine described his enthusiasm to “fix" the broken health care system. I wrote this response to the Annals of Internal Medicine and to the author.

The author's enthusiasm and sense of purpose are refreshing. I have always thought that if real change is going to come it must come from the younger generation. It is they who have listened to previous generations' complaints and it is they who see and are repulsed by the soul-sickness that has descended on physicians almost everywhere. What's more, the resilience and fortitude and stamina that are necessary to do the job can only sprout from their youth and idealism.

Many of us who have been in practice for 25-30 years have not had the uniformity of political commitment necessary to make real change happen.

I think David Stroh's generation will. Physicians of my generation started out in a mostly benign medical environment. Soon cost containment and regulation of fees were thrust upon us. Being ambushed so to speak, we were not ready or disciplined enough to make a strong stand against the powerful forces united against us. Worse my generation was victimized by an unprecedented slew of malpractice suits mostly frivolous that jaded many of them. The doctor-patient relationship was no longer seen as neutral ground but rather as one fraught with land mines disguised as frivolous malpractice suits.

New advances in technology made it more desirable to order imaging studies and lab tests rather than spend time at the bedside. Patients became intellectual challenges not sick people. Pushed by technology we somehow rationalized that it was okay to delegate the human factor of health care to nurses and physician assistants. Patients came to see many of us as detached and cold.

David Stroh's generation has the advantage of sitting back and assimilating all that has happened. Listening to older doctors' stories and frustrations should give him and his contemporaries the panoramic view that my generation was too close to to see clearly. The challenges facing these "knights of the white coats" will be great but the rewards of overcoming them will be worth the effort and sacrifice and perseverance.