Loss of Power

This country doctor lost power today in more ways than one.

During dinner tonight, with a hard rain beating against the windows and skylights of our family room and the wind howling outside, the lights flickered a couple of times and then went out. We always eat dinner with a kerosene lamp on the table, so we were not in complete darkness, and I quickly lit other kerosene lamps and the candelabra on the mantle of our Swedish ceramic tile stove.

Moments before this dramatic turn of events I had recounted for my wife this morning’s exchange with our clinic administrator, who had called me into his office to tell me that another physician at our clinic, five years my junior and with an internal medicine background, was vying for my role as Medical Director.

The way the administrator sees things, the future of our clinic depends on our ability to serve an aging population with increasingly complex medical problems. My colleague, the internist, prides himself in his ability to take complex internal medicine cases further before calling in specialists. Ironically, the way we get reimbursed is essentially at a flat rate, making longer visits a drain, while shorter visits are profitable for us.

The administrator told me in a roundabout way that my skills as a Family Physician in handling large numbers of acute visits involving pediatrics, GYN, minor trauma, orthopedics, ear-nose-and throat, ophthalmology and infectious diseases were needed to offset the costlier but less well reimbursed visits of the internist, but that I would be playing second fiddle to him because he deserves the title I’ve held for a dozen years.

My first reaction, I admit, had been one of anger. I helped build this clinic; in the first few years after I came here, our census doubled, and I created most of the programs and protocols in place today. After thinking about it some more, though, I admitted to myself that for any employed physician today, rural or urban, the non-medical people who run the clinics and medical offices we work in are free to bestow titles and “power” upon whomever they choose, and that is usually whoever serves the management’s purposes best.

I may not know what the ultimate purpose of our management is, and, as I was telling my wife just as we lost our electric power, the power I may have had as Medical Director was fickle, and subject to managerial whim, while my power as a physician and healer is something no administrator can take away from me; whether I see acute or chronic illnesses, I am following my calling in meeting my patients, one by one, where they are in their moment of need.

The one thing I will fight for isn’t the title, but my right to see my patients, the ones I have cared for almost a quarter of a century, as long as they choose to see me as their physician.

1 Response to “Loss of Power”

  1. 1 Feathers November 29, 2008 at 2:53 am

    Have read this before, liked your description of the kerosone lamps, sounds lovely.

    It is a sad fact that they choose people who best serve the managements purpose, not who they should be choosing.

    People are fickle and act on a whim and later regret deeply those actions, as they suffer the consequences of them, they begin to unfold, it becomes apparent wrong choices were made.

    However, you are much more that just a title as your blog illustrates all the way through, it is very clear you have a deep calling within you not only to be the physician and healer, but you also have a heart.

    Would it be that all patients could have a Doctor like yourself, who would actually state they would fight for the right to care for the patients they have cared for almost a quarter of century.

    It is a quality that makes excel in their fields. My dad died of non Hodgkin’s lymophona he went to to the cancer hospital, when i walked in knew it was so different, the nurses the doctors were exceptional people. Who worked within the field they did because it was their calling, he had great respect for them, i also learned why he did, it was different from anything else i have ever seen, will never forget what i saw the care and everything they did, above and beyond the call of duty. The walls were filled as well with letters and cards from people like myself who were overwhelmed with the care that their relatives had received there.

    Titles did not matter, the nurses and doctors were known more so for their exceptional qualities. That is how it should be, personally believe.

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Osler said “Listen to your patient, he is telling you the diagnosis”. Duvefelt says “Listen to your patient, he is telling you what kind of doctor he needs you to be”.


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