How is being a physician today different compared to when I started?
I was in my medical clerkship in my fourth year of medical school when I first interacted with a patient. This was at the University of the East Ramon Magsaysay Memorial Medical Center College of Medicine in 1969. My first rotation was in the department of obstetrics. I had to assist in the delivery of patient in labor, and the medical intern in charge was Herminio Mendoza, Jr.
First, we had to learn how to scrub our hands and arms clean, then how to put on sterile gowns and gloves. We entered the delivery room and there was this pregnant patient lying in the delivery table in intense pain trying to push the baby out. She was moaning and groaning with each labor contraction, and it was difficult for me to watch. It was then I knew I would not be an obstetrician.
As medical clerks, we learned how to take detailed medical history and physician examination on patients. We were required to have it typewritten and be able to share the information during medical rounds on the patient’s bedside. That time, having an excellent history and physical examination was a significant part of the care of patients because we had limited diagnostic resources. Yes, the amount of laboratory studies were few, no ultrasounds, no CAT scans, no flexible scopes, cardiac catheterizations, and many other procedures we routinely use today to evaluate the patients.
Working at North Hills Hospital in the mid-1990s, working on my hand written chart, note the Rolodex next to the phone
During that time doctors wore coat and ties at work. In the hospital when they got to the nurses’ station, nurses would offer theirs seats to the doctors, bring an ashtray if the doctor was a smoker and ask if he or she wanted some coffee. Some doctors would throw a fit when they did not get something they wanted and throw charts to the floor and get by with it. Try to do that today and the hospital will suspend your hospital privileges.
These day most doctors wear surgical scrubs and at times white coat over it. At the nurses station the nurses are busy catching up on their patient documentation in their computers or caring for their patients. If your want coffee you could get it yourself in the coffee room. All health facilities are now smoke free. Another change at the work place is what use to be called flirting is now referred to as sexual harassment which could result in loss of one’s hospital privileges.
Early in my career, medical malpractice suits were very rare. Hospitals and employers did not require malpractice insurance. My first malpractice insurance was $325 per year compared to $32,000 or more today. Because of the changes in medical liability, physicians have to put more detail in their documentation, and do more tests to insure the right diagnosis. We call it CYA, short for cover your a… These days if you are in emergency medicine, you are required to treat patients the best you can, regardless if they can pay or not.
I remember early in my career, after I diagnosed patients with a heart attack in the emergency room, I would tell the patients and their families the need for admission to the hospital. I would inform them we would closely monitor the patient. If the patients survives the first 48 hours, their chances of them making it was good and if they do well in 7 days, they may go home. These days, patients with acute heart attack right away go to have cardiac catheterization and get angioplasty to open up the clogged blood vessels or get a clot buster to reverse the heart attack. It is much the same way with strokes. Now a days if stroke patient presents to the emergency room within 3-4 hours after a stroke and if it is caused by a blood clot the patient is given medicine to dissolve it to re-establish circulation to affected part of the brain.
Today, we have Advance Trauma Life Support and Advance Cardiac Life Support protocols to care for patient which are started by paramedics in the field and continued when they arrive at the ER. I remember early in my career, funeral hearses served as ambulances manned by funeral personnel. There were no trained paramedics. If the patient died, they used the same vehicle to take the corpse to the funeral home.
When I started, patients’ medical records were all handwritten. I started work in a busy emergency room in Odessa, Texas, in the early 1970s. It would not be unusual for me to see 50-60 patients in a 12-hour shift. During that time, there were very few blood tests. We ordered plain x-ray studies when needed. CAT Scans, ultrasound, MRI, angiograms were not yet available. Documentation of patient were brief hand-written notes of two or four sentences of pertinent findings.
As emergency medicine became more complex and with medical liability increased, documentation needed to be more detailed and took up much of the time of the physicians in the care of their patients. More tests has also to be done. In a 9 hour shift, I would be able to 22-26 patient on average even with the help of a scribe.
To help us physicians in ER to speed up documentation and see more patients, hospital introduced the use templates for different illnesses in the late 1990s. Eventually, in the early 2000s, hospitals implemented complete electronic medical records. This change l welcomed because I have used computers since they come out and I learned to type as freshman in high school. Not having good penmanship, I now could read my own notes.
As a patient myself with electronic records, I can know more about my care with my primary care physician, endocrine oncologist and radiation oncologist. The physicians have access to record of your other physician so care is more integrated. I just go to the patient portal and check my appointments, plans, findings of test and communicate with my doctors when I need to. Today in the state of Texas if a patient is prescribed a narcotic their names go into a state registry so before physicians prescribe narcotics we have to check the patient name for prior narcotic use. This is intended to prevent narcotic abuse by patients.
With availability of medical information from the internet patients and their relatives may preconceived knows of their illnesses. This may be a be a two edge sword. I maybe good if they obtain the right information from a reliable source but if the run in wrong information it may take more of the physician time to clear up misconceptions. More than 25 million people will use the internet to search for health information, says the Federal Trade Commission. Estimates vary at the number of medically related sites are on the web, but they number at least 100,000. Only about half these sites have their content reviewed by doctors. The danger is medical websites that would lead patients to diagnosis and treat their own conditions. “There’s a reason why doctors go through years of training.”
I remember my father in his late thirties was diagnosed to have bleeding peptic ulcers and his doctor prescribe him to drink milk every few hours when he was awake. He brought a thermos to work filled with milk. This was the standard of care then till studies showed that this did more harm than good. Today, the treatments should be supported by Evidence Based Medicine (EBM). EBM means medical practice or care that emphasizes the practical application of the findings of the best available current research. Lately however when the pandemic started politicians got involved in recommending treatments and prevention measures for COVID. To add to this social media adding conspiracy theories and medical people claiming to be experts supporting what politicians promoted. This has made it more difficult for medical practitioners to apply EBM.
As a cancer patient myself for the last 17 years, I know many of the tests used to monitor my illness were not available early in my career, so also the treatments that I have benefited from. I don’t think I would be around to share this story today were it not for these advances. I thank God for medical progress.
“……even to the time of the end: many shall run to and fro, and knowledge shall be increased.” Daniel 12:4
