Sunday, June 26, 2011

What my children will never see? Things disappearing from the doctor's office

On a recent trip to Austin I flipped through the worn copy of Spirit magazine in the seat back of a Southwest Airlines 737 and saw this nice article about babies -- and specifically what they see and understand very early in life.

I love my two young kids, and although they both aren't as young as they used to be (neither am I), I love to share with them new experiences, sights, and the general joys of life.

I think all parents must feel the same way.  There is just something about seeing the the glint of newness and understanding in the small eyes of a child.  

But today I began to wonder about things our children will never see, particularly related to health care. We have on our own list from when we were growing up, but it's certainly different now.

From polio, mumps, and small pox:  thankfully they are all distant memories.  As a dermatologist I do get to see some of the unusual but still rather rare diseases (measles, for instant) that I heard about in my childhood.

But children today will miss out on many things that are common place in our day to day lives.

Here's my list (feel free to add or subtract in the comment box below):

1) Marcus Welby:  hometown physicians in private practice that take care of families for decades will be a thing of the past.  I've written about my good friend John Keller, MD, a family physician in the small rural town of Fairfield,  Texas before here.  Practicing for over 50 years in one place, he will probably be the last "Marcus Welby" doctor that I know.  And my children will never see that.  Only on re-runs. 

2) Chicken Pox:  childhood vaccination makes this common disorder now very rare.  And, if we're lucky, shingles or herpes zoster will also be a painful encounter our kids will not have to endure.

3) Rectal thermometers:  I'm sure someone will comment that these are still around.  The last time my kids were sick it seemed like someone just shot their head with a laser thermometer -- nurses don't even have to touch the patient any more.  Novel idea.

4) White hats:  speaking of nurses -- what about those white hats?  I mention them occasionally and finally someone in my office told me that she wasn't sure it was politically correct to talk about them anymore.  I'm not sure I understand that, but I've changed my workplace banter after their expressed concern.

5) Prescription pads:  Ok, I know this is maybe a tad progressive.  But in our  paperless office we don't write prescriptions by hand any more.  We send everything electronically using an e-prescribing application.  And, frankly, everyone loves it including my staff, patients, and finally me. I know there are some slow adopters out there, but Medicare and other insurance carriers will drive that train.  Paper prescription pads? They'll be gone.

6) Drug company pens:  Yes, the pharmaceutical company give aways (not just pens: but dummy plastic models of the skin, Post It notes, stethoscope labels, you name it) are all gone.  No longer will kids see a Viagra pen or a Lipitor flashlight.  New pharma rules prohibit these types of "inducements" because some bureaucrat thinks that supplying a pen will induce the doctor to use that pen to write an expensive prescription.  Personally, I think this is stupid.  Maybe doctors shouldn't be taken on golf junkets or expensive dinners...but a pen.  Really.

7) Ties:  Though not mainstream, health care workers are quickly adopting the casual Friday look in the medical office and the hospital room.  Why?  Well those ties were shown to carry germs.  So scrubs and casual shirts are now considered appropriate dress code for health care workers.  

8) The Co-Pay:  Well, it's not gone yet, but more and more insurance products are "high deductible" health plans.  It used to be that patients could pay $20 and get all the health care they could milk out of a 15 minute visit.  Those days are disappearing as the most popular insurance product sold in our home state last year was one with a $3000 deductible.  Patients and physicians are now more cautious in their health care decisions.  That's a good thing.  The bad news is that every care component falls directly to the bottom line.  

Feel free to add or subtract from this list.  Hopefully there will be exciting improvements in our health care delivery system, new drugs to treat disease, and exciting technologies to cure our ailments that replace the items on the list.  

We can always hope.

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