It's late summer 1997, first thing in the morning. Young Frank has just answered his phone and been offered admission to med school. Lifting the receiver and weighing whom he should call first with the news, he finds the line has gone dead and all ambient noise in the house has stopped. Confused but still elated by the moment, he turns around to see his older self, Old Frank, standing in front of him.
Old Frank: Hello Frank.
Young Frank (startled): You're me. An older me.
OF: I am indeed. I'm you about twenty years from now.
YF: Balding with a pot belly, huh?
OF: Smart-ass. The hair loss is genetic, so deal with it. As for the pot belly, all I can say is on top of getting past your laziness, you really should learn to stretch. Speaking of which, can I sit? Time travel does a number on the sciatica.
YF: I get sciatica in the future?
OF: You have many years before you need to worry about it. But like I said, you should learn to stretch. (sits down gingerly) It's not the worst thing you'll have to deal with.
YF: (points to Older Frank's hand) Holy...I get married?!?
OF: With children, just like the TV show. You do good by us on that front.
YF: So what brings you here? Or me here, I guess. Or should I say what brings you now? Can you give me any stock tips for the future? Who wins the World Series?
OF: Sorry, it's forbidden. Causes glitches in the Matrix.
YF: Glitches in the what?
OF: Right, 1997. It's a movie, and it hasn't come out yet. I'm joking anyways. Look, even if I told you who wins what, or what day the stock market crashes, it won't do you any good. This conversation only sticks around in your deep subconscious.
YF: So what are you here to tell me then?
OF: I'm here to tell you that in my time, twenty years from now, Family Medicine will be in grave danger.
YF: And it will be up to me to save it?
OF: Bwahahahahahahahahaha!! I forgot about that inflated sense of self-importance we had back in the day. No, the fate of Family Medicine most certainly does not ride on your shoulders.
YF: Two things, then. First, I've literally just been accepted into med school. Like, just this instant, until you stopped time. I haven't even told my - sorry, our parents. If the future of anything doesn't rest in my hands, why are you here? And second, can I just say this is the all-time worst advise-your-younger-self moment, ever?
OF: Are you finished?
YF: I don't know. Am I?
OF: (groans) Here's the thing. In the future, people stop listening to reason, and even start willfully ignoring facts. You, that is to say we, still do. So I've come back in time to make it our mission that you stay on top of these things. Plus, this is a fun way to shake up the format of your blog posts.
YF: My what?
OF: You know those conspiracy-theory websites you visit to kill time? Where people post diatribes alleging things like, 'Papa Smurf is a Communist' and so on?
YF: I do.
OF: You have one of those, or will. In fact, everybody and their dog has one of those websites, and in the future it's a perfectly acceptable way to transmit analysis and opinion. Even if you know nothing of what you speak, you can build a massive and captive audience.
YF: Do I? I mean do you? Build a massive audience, that is?
OF: No. God, again with the inflated sense of self-importance...
YF: Yeah, yeah. So what's the persoalan with Family Medicine?
OF: In the future, people in medicine don't want to do it. As in, they don't want to pursue it as a career in the first place, they find ways to restrict their practices and become de facto specialists, and they just flat out aren't doing what traditional family doctors are "supposed" to do.
YF: Why is this happening? Is it fee-for-service medicine? I read a lot about that in the newspapers.
OF: They still pin the persoalan on how and what doctors are paid. If you think things are slow to change on soap operas, wait until you watch the pace of change in health care. But I digress.
There are many causes of the problem. Family Medicine decided it wanted a divorce from the specialties in the late 80s, and that divorce was finalized in the early 90s. It's caused a steady disrespect for Family Medicine to grow in the medical schools. Now that the old guard - doctors that were general/family practitioners before retraining as specialists - are mostly retired, that disrespect has run amok.
You'll find in time that, for non-surgeons, medicine as a whole becomes less and less about diagnosing and treating a patient, and more and more about managing chronic, disabling health problems - and a few "diseases" that are inventions of drug companies. It's created a lot of paperwork and headaches for family doctors, tilting at windmills of bureaucracies that don't listen and don't care. Since how and what doctors are paid, even in your day, is an anachronism that dates back to the 1950s, newer doctors are thumbing their nose at a job with too much grief and too few rewards.
We also become obsessively preoccupied with computers. You'll see a lot of enthusiasm for technology as a solution to everything in health care. It isn't, and it will make life miserable in medicine, especially for family doctors. See, governments love collecting data on what doctors do. Rather than using it for research and policymaking, however, they use it to place ever-increasing demands on doctors. The quality of your work is no longer determined by your relationship with the patient, but rather a bunch of numbers - what percent of your patients have regular cholesterol tests or mammograms - that really don't mean anything.
The other part of what you might call the computer persoalan is the internet. By the time you're my age, the internet won't just be for conspiracy theories and porn...actually it will, but it will also be a repository of medical information both good and bad. Many of your patients will diagnose themselves with every disease you can imagine, pressuring you to order tests, make referrals, or prescribe what you might not agree with. Trying to set the record straight five or ten times a day wears you down after a while.
You and your young colleagues - especially the growing numbers of women in medicine - will find they have more household responsibilities than the old-school doctors. Doctors have working partners rather than stay-at-home wives, and--
YF: Partners? Like business partners?
OF: I'll stop time at some other time, and tell you the ins and outs of political correctness, though it's a moving sasaran even in my day. My point is the days of a male doctor working dawn 'til dusk while the wife raised the kids and made dinner are gone. It makes it harder to get doctors into rural areas, and the vast majority of family doctors don't deliver babies anymore.
Then you have the other "traditional" places family doctors worked. The specialists booted family doctors out of the hospitals in the 1990s when beds were cut. Emergency Medicine demands far too much in the way of specialized knowledge and skills to be a viable place for family doctors to do the odd shift here and there competently.
The sum total of all this is that Family Medicine is a discipline where much of the work is no longer what one might instinctively think of as "medicine". It begs the question of what the job is supposed to be, and why a young doctor would want to bother with it, except as an expedient way to enter independent practice.
And don't take my word for it. You know who thinks family doctors are expensive and redundant? Health Ministers, including one who used to head the Canadian Medical Association! Imagine doing ten years of post-high school education and training, amassing 200k in debt, and hearing that.
YF: That all sounds crazy. And frightening. Why aren't the Powers That Be taking radical steps to address the problem?
OF: I told you, in the future people stop listening to reason, and start willfully ignoring facts.
YF: What should I do? What will I do?
OF: You, that is we, aren't the ones to fix anything. Just do what you can to see the truth, and speak it as you see it.
YF: I will. Anything else?
OF: Watch your mouth...and learn to stretch.
Old Frank disappears and the passage of time resumes. Young Frank picks up the phone and delivers the news to family and friends. Later that day, he gets a tight hug from a family member that causes a crick in his back.
Family: What's the matter? Back bothering you?
YF: Yeah. I'm sure it will be fine in a day or two.
Family: You know, getting into yoga or a good stretching routine will go a long way towards helping your back.
YF: Learn to stretch? Pfft....
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Sunday, January 14, 2018
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