Thursday 29 June 2017

The Honorary Doctor.

   It's about three years now since I retired (or is it four?).  I'd been practicing Medicine for about fifty-five years and I was never bored with my job.  Frustrated- yes often.  Exhausted- yes, very often.  In those days if you delivered a baby at three in the morning, you didn't get the next day off.  You were at rounds at eight am or if you were lucky nine.  I can remember an occasion when I  delivered two sisters on the same night, one at two am and the other just was ready soon after I had got back to sleep at five am.  I had normal office hours the next day, though I did ask one of my partners to make hospital  rounds on my patients that day.  Doctors did that for each  other and for their patients in those days.  I was no exception to  the rule, that was the standard.  Many doctors actually cared about their patients as they would about friends and indeed many patients were friends or became friends, though I'm not sure that is such a good idea. 
  I can honestly say, that I never feared a patient would sue me and I  never had a suit against me or even a threat of one.   Being a rather but not completely naive individual, I believed that I could present anything I had done in the area of patient management, as being done in the belief that it was in the best interests of the patient, and I believe my patients thought that too.  We were on the same side, I believed I was acting in their best interests and so did they.  If I was worried about something I had done, or something I had not done, I discussed it with my patient.  I thought they would think I was an idiot when in fact they thought, correctly, that I cared.  Sounds pretty corny, eh?  But in an era where doctors were quitting practice because their insurance overhead was so high, the Canadian Medical Protective insurance informed me that they would continue my coverage without further premiums to me as they had never had to provide service to me.   By the way, not long after that, they discontinued this practice because paying members objected to the practice, not recognizing that we, the lifelong suit free practitioners were subsidizing them, not the other way around.   
   I was a competent though not particularly scientifically smart doctor, but I knew the areas where I was exceptional and those where I needed specialist colleagues to help me out.  Even the relationship between the specialist and the GP was very different then.   I recognized early on, that the technical knowledge of my specialist colleagues far exceeded my own.  Many of them had spent enough time doing general practice to have considerable insight into the myriad problems it presented.  Indeed, it was often the catalyst that encouraged them to specialize.  I developed a network of specially competent specialist colleagues in my early days of practice in Regina to whom I referred patients, but whose brains were mine to pick when I needed to.   So, I would call my colleague about a puzzling case, (No multi-level answering service if he was not there, just leave your number and he will call you back - and by God, he did, even if it was after supper!)   The conversation would go like this"
  Hey, I saw this patient today, she had A + B +C +D.  I was a bit worried that she might have  something more than E going on. Do you need to see her ?  
  He might say did you do E +F +G?  If they are okay just carry on with the treatment you prescribed  otherwise I better see her.
  All this was done without any recompense to the  GP or the Specialist.  
  It was a part of professional etiquette which was done as a favour.  Note both the GP and the patient were the recipients of the favour.  
   Something that might require two or more consultations and taking weeks (or months) of waiting for appointments, were dealt with, without recompense by two committed physicians over the phone.  
   I guess the folks just didn't know when they were well off!!
   No wonder the health care system is going bust!!
   I didn't even get started on the Honorary Doctor, I guess you'll just have to come back - or not!

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