As Dr. Richard Gross, a retired pediatric orthopedist who graduated from medical school in 1965 and recently won a Humanitarian Award from the Pediatric Orthopaedic Society of North America, said, “Health care delivery and medical care cost remain as the major concern of most Americans. The perception of many patients is that they are alone in wading through ever-increasing complexity. They feel they are alone dealing with powerful insurance companies, alone fighting big pharma to get their medications, alone when looking for healthier ways to live and alone in the doctor’s office with no one explaining or interpreting where they stand.”
At HealthLinks Magazine, we are in constant contact with doctors and other medical professionals on new and innovative medical inventions that make living a healthy lifestyle easier or at least more attainable. Surgery is less invasive, with quicker recovery times, procedures like Lasik have become much more commonplace and there’s a “fix” to almost any cosmetic blemish you might want removed. For retired surgeons like Drs. Gross, Peter DeVito and Biemann Othersen, who practiced in the Charleston area for over 40 years, beginning their careers in the 1960s, they have seen firsthand the changes – some good and some bad.
We sat down with Drs. DeVito and Othersen to find out just what stands out as the biggest changes and what they think could be improved.
HealthLinks: In what ways has medical school changed?
Dr. DeVito: “I remember when I was in medical school at Duke University in the 1960s, the dean said to look to the right and then to the left and that one of those people would not be in med school in a year and he was right. But, on the other hand, the professors would also say that we admitted 70 students and we will graduate 70 doctors. It was so hard back then. Now young people are just pushed through. The explosion of technology has really tampered with the artistic technique of surgery, and the one-on-one relationship with the patient is not emphasized as being important anymore. We used to do four basic areas for rotation for internships. Those were surgery, internal medicine, pediatrics and OB. We would also do some psychology. But that has all changed due to all the new subspecialties that were not around when I was in school. Some specialties like ophthalmology will have to have a residency secured.”
Dr. Othersen: “I started medical school in 1949. I felt like I was just trying to hang on back then and was just barely keeping my head above water. My son went to medical school and enjoyed it. His experience was so different than mine. The biggest difference is all the technological advances, and these doctors have to keep up with all that. I believe that softer touch has become lost. High tech demands high touch.”
HealthLinks: How do you feel insurance has changed the way doctors practice?
Dr. DeVito: “This is a big reason why many doctors cannot practice on their own anymore and that there are more larger practices with many doctors under one roof. They cannot afford the malpractice insurance on their own, nor can they handle the manpower it takes to process insurance claims. The larger hospital corporations have the manpower to do all of this, so it is easier for many doctors to work for one of those now days. Insurance companies now tell the doctors how many days their patients can be in the hospital systems.
We have to get prior approval for almost everything. Even certain medications can’t be prescribed without their approval, which can take a while and, in the meantime, the patient is suffering. It is like they are telling us how to practice medicine and it does make it hard sometimes.”
Dr. Othersen: “Before Medicare, which was instituted in the 1960s, it was just private companies that offered health insurance, so many people just paid for medical care with cash. Now you have to have some kind of insurance and it is very expensive. I think the dawn of Medicare really made the difference with changing health care for doctors and how it has limited them ever since.”
HealthLinks: What is the biggest change you see with pharmaceuticals?
Dr. DeVito: “Medications are completely controlled by insurance plans. So many necessary meds are just not covered, and that makes them very expensive. It is impossible for some people to be able to afford the meds that are essential to their quality of life.”
Dr. Othersen: “Well, the one good thing is that there are more medications now that can help with more things. But, you see, we didn’t used to have advertisements for medications. These advertisements are going directly to the patients, and it makes the patient/doctor relationship hard because the patients don’t exactly understand these meds that they are hearing about on TV. I feel like the advertisements are going in the wrong direction, rather than truly helping people.”
HealthLinks: How has the issue of malpractice changed the profession?
Dr. DeVito: “Having to defend yourself all the time takes away from the level of care you feel like you can give someone. That patient/doctor trust is gone. Other people have to be in the room for legal reasons or the doors have to be open when you are trying to privately speak to the patient. Doctors are constantly worried about it.”
Dr. Othersen: “In some professions, like neurosurgery, the premiums are very high. It sometimes cost too much for the doctor to even fight some of the lawsuits, so more often than not, they just settle. It has really weeded out so many good doctors because many won’t go into a profession that has a high instance of malpractice.”
HealthLinks: What is your advice to doctors and prospective doctors on always keeping what is best for the patient as the number one priority, above all else?
Dr. DeVito: “Medicine is as much about the art of it as it is about the science. In surgery, we are laying our hands on someone’s wound and healing it. It is a private relationship between a doctor and their patient. With all the negatives there might be in the system, we have got to remember what is best for the patient.”
Dr. Othersen: “That is crucial. Everything you do has to be for the benefit of the patient. They have to trust you. Some doctors have to see a certain amount of patients in a day, and their relationship wanes because they don’t get the time they need with them.”
HealthLinks: What is the biggest change you have seen over the years?
Dr. DeVito: “Explosion in technology and the difference that has made in surgery. Laparoscopic technology and microsurgery have revolutionized surgery. All the credentialing and licensing, malpractice, continuing education – all of that is so exhausting and you feel bombarded. It is hard for young doctors to keep up. But I support them and will do what I can to help.”
Dr. Othersen: “I started practicing in the mid-60s. The biggest change I have seen is how threatened the patient/doctor relationship has become. We need to empower our patients and get to know them. There are three things that I think if every doctor did, it would greatly improve the practice: 1 – introduce yourself and what your role is; 2 – wash your hands with soap and water, protect the patient from germs; and 3 – sit down to talk to them. Don’t rush. Ask them to explain the problem and talk to them face to face. I think if all doctors did those three things, it would help tremendously.”
Dr. Gross concluded with a quote from the American Medical Association, “It is necessary for both the individual physician as well as the physician body to speak out and stand up for those principles that guide the patient/physician encounter and are part of the fiduciary relationship with patients.”
By Theresa Stratford with Drs. Peter DeVito and Biemann Othersen, both local retired surgeons