Leaving home

I learned to be a doctor in hospitals. For my generation, there was none of today’s going out into the community to see what it’s like—the patients came to us and our superiors told us what to do. So when I became a doctor, like many of my colleagues I stayed in the hospital. And stayed. 

That was it until the end of last year, when I ventured out into the real world (or the “dark side,” as hospital-based purists see it). Seeing patients in a setting other than a hospital took some adjustment, because the hospital environment leads to a singular way of doing things. But after the adjustment, it became clear that there are advantages to working in a free-standing unit (and no, Dr Brian Day had nothing to do with this epiphany). My observations have been made previously by others, and naturally there is a tendency to view the new environment through rose-colored glasses, but I still like what I have seen. Here are some of the things I have concluded:

A hospital is a hospital, and anywhere else is not
The most frequent comment from patients who have come with me out of the hospital is “Wow, this is nice!” The environment can be whatever you want it to be in the outside world, with the views and decor that we all like, whereas the hospital environment arises from what the budget and the administration allow. Hospitals must guard against the greatest possible threats, such as superbugs and physical violence, whereas a private unit is unlikely to face these threats. The point of a hospital is the provision of serious care, but it must also concern itself with the administration of complex programs. Outside the hospital the patient is the point.

A hospital is a department store; a private office is a mom-and-pop operation
While practising in a hospital meant that most required services were available within the facility, being outside means that not everything comes im­mediately to hand. Hospitals have specific people to do specific jobs, but in a private unit it helps to be generally capable. I understand and respect the need for unions—a big organization can’t function efficiently without them—but there is something attractive about having whoever is first on the scene fixing the problem. It certainly helps keep morale high.

Institutional pride is one thing; pride in personal accomplishment is another
Having a place in an institution or corporation with a reputation for excellence instils a feeling of pride, but it is not the same as the pride that comes from unique personal accomplishment. Both are desirable, but the former relies on the performance of many people and the systems that make them function together. The latter won’t attract as much attention, but the feeling of reward is more intense. Building a practice or unit from scratch, and then establishing a reputation for excellence in that practice or unit, is about as rewarding as it gets in the business of medicine.

I’m excited to be in my new location, and I am astonished by the all-round capabilities and cheerfulness of all who work there. The continued presence of trainees is a link back to the hospital and keeps me on my toes. Of course, medical practice in any location has its business side, so naturally I have always listened to what politicians say and I read the financial pages closely. But since leaving home I am paying more attention, especially to the politicians. I can confirm that there are clinicians in both hospital-based and independent practice who strain to do their best with the resourc­es they have, and do an outstanding job. And, as has been said before, each group thinks that the other has it easier. Of course, they’re right.
—TCR