By: Dr. John Fatti
I'm in my 31st year of practice in Orthopedics and Hand Surgery- all with one great city- Syracuse, NY. That is a fairly long career- lots of time for the practice of medicine to change- mostly for the better.
I remember when: patients were admitted to the hospital THE NIGHT BEFORE carpal tunnel surgery. They had their surgery in the hospital- a 3 inch long incision- STAYED OVERNIGHT UNTIL THE NEXT DAY- and were discharged the next morning.
Now: those same patients come to the surgery center just before surgery, have their surgery usually in less than 20 minutes, through a half inch incision, have a recovery room time of about half an hour, and are driven home
I remember when: Taking call for the emergency room was eagerly anticipated. It was the best way to build a practice.
Now: Taking emergency call is complicated, fraught with complex patient problems that require weeks of follow up. No longer the welcomed experience, it is now an “accepted” responsibility of hospital care.
I remember when: I joined the orthopedic private practice in 1985- there were 5 doctors. There were 10 employees to sign in the patients, collect the bills, do the transcription, do the X-rays, put the casts on , take the stitches out, schedule the surgery, call the patients back, etc.
Now: 30 docs, 30 midlevel providers, 589 other employees to do the great orthopedic work we do now at SOS. Every one of them necessary - because medicine in 2016 makes it so.
I remember when: You walked into the room in your office to see a patient and you listened to them, looked them in the eye, began a relationship, examined them, made a diagnosis, ordered some tests, had time to calmly explain how things were going to progress, step outside the room, and speak into your dictaphone a logical meaningful note, and move on to the next patient.
Now: I walk hurriedly into the room, introduce myself, the patient is telling me the problem, my attention is divided between the patient's face and my computer screen, we make a plan going forward, we'll call you when/if your insurance company approves your MRI or your NCS. I complete the EMR note sometimes. Sometimes I don't. I average completing 20/40 notes that I have in a full day of seeing patients. Twenty years ago, with my dictaphone, a full day was seeing 65 patients, not 40 like nowadays. Ultimately , we reach the same endpoint “now” as we did “then” a plan of care to deal with the problem, but the path isn’t so straight forward.
I was younger then. Medicine was different then. But, despite the additional complexities, it's better now.