Of Mice And Men

My eyes popped as I stared at the graphic accompanying the article which showed a red gleaming apple sitting on a desktop next to a ruler. The caption was in large bold letters.

Primary Care Goes Back To School!

The article described how internists and family practitioners are falling short of meeting current guidelines for the treatment of common cardiovascular ailments.

Another recent study noted that the number of specialty referrals per patient has skyrocketed over the last decade. Of course, you know who is being blamed for that one.

We are facing an identity crisis in Internal Medicine. The older generation labors under intense pressure to maintain salaries and finish paperwork. They struggle to complete their daily tasks in a ten hour day. The younger generation is all about lifestyle. They are accepting bloated salaries from desperate health systems to work a nine to fiver without call or hospital responsibilities.

And in the midst of the chaos, an ancient relic is being lost. The Internist, pejoratively known as the flea, would grab hold of his patient and never let go. They were scholarly, brooding, scientists who were challenged with the most difficult cases. There was intellectualism and pride.

The "hand off" is becoming the hand over. As we release ownership of our patients and leave the deep thinking to the specialists, we not only abandon rational patient care, we erase the need for our own existence.

Countless non physician practitioners are chomping at the bit of clinical care. They both climb the professional ladder as well as wait for our skills to degenerate. And to the joy of health care reformers, they ask for a lot less payment in return.

Today I call for elevation. Are we going to use the craft we fought so hard to obtain or are we going to wait for extinction.

Long ago, giants roamed the earth. The question for today's internist:

Will we be mice or men?