THE CHANGING FACE OF FAMILY MEDICINE-SCOTT SITNER

Yes, another article about how family practice is not what it used to.  We all know that.  Insurance, regulations,  computers, doctors who don’t care, don’t speak English, move every three months.  We all know that.  This has been written about ad nauseum and to go over it again is a waste of  words.  This is being written from a standpoint of an observer at close range, the son of a doctor, who over ten years has been involved in the practice as attorney, advisor, manager and marketer, in some sense trying to get the doctors, who have owned the clinic in the depths of southwest Detroit for 51 years, to transition to today’s mess of health care.

51 years ago in May of this year, Drs. Jerome Sitner and Gerald Uzansky acquired Junction Clinic.  In a thriving area of Southwest Detroit, blocks from the Cadillac factory, down the street from dozens of industries, and in the middle of neighborhoods, actual neighborhoods, where all of their patients lived, they opened a  traditional family practice.  In those, before I was born of course, people knew their doctors,  the patients grew with the area, the families grew with their doctors.  They knew everything about each other, the good, the bad, the middle.  It was a true definition of family practice.  When a patient died, the doctors thought nothing of going to the home to visit or to go to a funeral.  It was second nature, this was family, you treat them as such.  For decades that was the way.

Caught partially by the downturn of Detroit, and partially by changing times in medicine, things changed.  Patients  moved, factories closed, houses became vacant, burned.   I remember going for a shot as a kid and seeing a car literally on fire next to the Clinic.  An hour later, it was still burning, no one cared, it was the norm.  But through this, and through many opportunities to move to the safer and wealthier Detroit suburbs, they stayed.   Shunning more money, safer areas,  angry wives, and “better” patients, they stayed .  Treating their patients,  their family, even if that family became less interested in the doctors’ families and more interested in walking in and walking out.   Such was the area, the changes, the times.   Yes it was still profitable and to say that there was no financial benefit would be to lie.  But that was never the goal.  In those days,  you stayed.  You took care of the neighborhood, the patients, you did not cut and run.  There was an inherent obligation to the area, even if, frankly, no one else cared. Businesses left in droves,  neighborhoods literally were crumbling  but the Clinic remained.

Now, in 2015, the doctors, 78 and 77 years old, stay.  But medicine, or the business of it, has moved forward.      The last ten years have seen a dramatic downfall in doctors running their own practices, where they have a vested interest not just financially, but in the patients, in the practice and in growing with those patients as people not charts.    This is not so much that doctors don’t care, or lack motivation,  as a practical matter it is now impossible to do so.   We have all read about the tens of thousands of pages of regulations, but how many of us have seen offices grappling with those changes?   Trying to make sense out of a morass of rules, regulations and orders that often conflict with each other. That make no sense and hinder patient care.  How many of us have been to a doctor recently only to stare at the top of a head while they type your reports into a computer.   When was the last time at your annual physical you felt you were talking to your doctor rather than answering a checklist to satisfy an insurance company so the office gets paid?

What has changed in the face of medicine is not so much the base quality of care, but the care of the providers, the ability that they used to have to see patients and really treat them as people, not as a model in a computer derived by a programmer not a doctor.   I look at the frustration in the eyes of my father and his partner, who are long past doing this “for the money” and see how frustrating it is that they cannot be doctors, but rather  have to be administrators.  Spending time trying to figure out why ten thousand dollars of charges resulted in a $432 payment?  Trying to learn why the government is making them spend $150,000 to implement a computer system, but not showing them how to do it, just telling them they have to their payments for treating patients will decline. . But mostly I see the lost art of seeing a patient as a person, not just a chart. No matter what, that will never come back and as a practical matter cannot.

The phrase “those days are gone” is overused, but in this case true.   I truly believe that we will look back with sadness and some shame in another decade as we treat with a computer and not a person and the lost are of medicine is gone, replaced by who knows what.  In my dad and his partner I see the lost face of medicine, all in the name of progress.

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