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Autobiographical Essays
Beate Caspari-Rosen, MD (1910 - 1995)
The Good Old Family Doctor
We all know from our youth the family doctor and perhaps the sentimental picture of an older doctor sitting on a chair near a child's bed taking the pulse of a sick child while anxious parents look over his shoulder. These physicians would treat all ailments from head to toe of mother, father, child, and grandparents. They would know the history of the family and give advice in childbearing, marital troubles, and take over the role of a psychiatrist. Their services were available day and night at the office or the patient's home. What happened to him?
As medicine developed it became specialized. For a pain in the neck one visited the orthopedist, and for a pain in the ear the E.N.T. specialist, and so forth. Most of the time the findings were or are not coordinated. Young interns in a hospital would continue their medical education after medical school by choosing a specialty and getting their training without ever having treated a patient outside a hospital. Machines took over. Taking a medical history became a lost art. The patient is given a long list with questions. He is supposed to fill out the answers. Routine laboratory tests are done before the physician even sees the patient, and in extreme cases the results of these tests are fed into a computer which spits out a diagnosis. In this whole process the patient with his physical and psychological problems got lost.
Physicians and patients revolted. There is now a new specialty: the family physician. He is a highly trained internist with special training in pediatrics, gynecology, psychology, and psychiatry. The patient is again treated like a full human being and ideally with deep understanding of the problems of the family also. Not many young physicians choose this branch of medicine. It is not as financially rewarding as other specialties, and often such physicians encounter a certain snobbishness among specialists who may be condescending toward these colleagues. But even here house calls are being avoided. This is partly due to the fear of malpractice suits, for without the backing of laboratory tests at the home of the patient the physician may overlook a symptom.
Let us welcome the family physician again in our midst and give him the trust and confidence we used to accord the venerable image of the family doctor.
I do not wish to go into the issue of malpractice suits and the high premiums physicians have to pay to insure themselves. This insurance forced many older physicians to stop practicing before their time of retirement. The public and lawyers are guilty mostly guilty for have driven the medical profession into such cul-de-sac. Many of us probably still remember the expression "ambulance chaser" Even the best--trained physician may make a incorrect diagnosis and a patient is free to seek a second opinion. In fact, most physicians welcome it. For the fear of a law-suit is lurking in the back of each doctor's mind.