I so felt a kinship to Dr David Richardson and Dr Cynthia Verchere who wrote about two issues I have felt quite unhappy about for some time now.
Privileges, those which our “older generation” doctors were part of, and which are no longer the norm, have degenerated to such a level that I no longer am attracted to such institutions and have distanced myself from them exactly because of all the poignant details outlined in the piece.
As a GP, I no longer feel welcomed, encouraged, or supported in a manner conducive to embrace this part of care, and more often feel frustrated and embarrassed to explain or justify the fragmentation of care my patients experience, or the many tales of disrespect accorded my patients there—being shuttled about with little explanation, being simply pawns in a game of financial struggles.
I do understand the unfortunate pressures the heroic staff struggle with, and who do try to regain the nobility of the past to little avail, and yes, I do fear when it will be my turn to be a patient needing such care. I agree that many an institution has become “a shadow of its former self,” per Dr Richardson.
I myself often still use the phrase we bantered about during those days I was actively involved in trying to preserve better care: “Hospital administrations would be so happy and efficient running hospitals if only without patients!”
This conundrum may well be mirrored in the editorial by Dr Verchere opining the days where postgraduate streams, having started with the general rotating internship, produced better clinicians with a broader feeling and comprehension of the wide diversity of care that is needed. The pressures on medical students to stream their focus and studies starting in the third year of medical school must be taking a toll as explained so eruditely by Dr Verchere.
She outlines the near impossible task of selecting with wisdom and compassion the optimum candidates for any particular residency, the hopes dashed of those who miss the one and single chance at their holy grail. What a Gordian knot, and I am sure many nights of headaches! Any outsider would say we have gone backward in medical education, but this shouldn’t be accepted, and the powers-that-be should fully revisit this sad state of affairs.
Often the comment is made by more experienced clinicians that the better-rounded specialists have some GP experience because they understand the spectrum of care from primary care/family practice through to the level of specialty.
I cannot help but see the connection to Dr Richardson’s editorial as the compartmentalization engendered by too early streaming leading to fragmentation of outlook, empire-building, and difficulty in cooperative, multidisciplinary efforts. Is there truly hope for our profession?
—John de Couto, MD
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