In all the time I've been writing about physician practice management, one refrain I've heard countless times is that "the days of Marcus Welby are long gone." And considering the 20,700 Google search results for that exact phrase, I'm clearly not alone. A blog post from A Country Doctor Writes, however, points out how "many people seem to speak of him without actually having watched or at least remembering much of the show."
And although I've had a general idea of the lost days the show represents for many--a time when middle-of-the-night house calls were standard and insurance denials did not exist--I had never seen an episode myself.
I hadn't, that is, until a snowy weekend afforded me the opportunity to catch up on a day's worth of small-screen entertainment, most of which predated my own existence.
The February 8, 1972, episode of Marcus Welby, M.D., I happened to catch was entitled, "Is It So Soon That I Am Done for--I Wonder What I Was Begun For?" It was about a young and nervous mother, Amy, who experienced every parent's worst nightmare--the death of her newborn baby to Sudden Infant Death Syndrome (SIDS).
Indeed, Welby and his colleague Steven Kiley, M.D., spoke to the bereaved parents with compassion, even while being accused briefly of medical negligence. In some ways, the dynamic between patient and doctor seemed far more like close friendship than a distanced, professional relationship. The young Kiley not only suggested the parents attend a SIDS support group, for example, but offered to attend with them.
I was also struck by Welby's mentorship with Kiley. Welby was understanding and accommodating of the young doctor's request for consults on his patients after the death of the infant he'd given a clean bill of health. But after the fifth time or so, Welby's reassurance took on more of a tough-love tone, as he declared it time for Kiley to stop second-guessing himself.
This brings me to an aspect of old-fashioned medicine I'm not sure I'd miss. As this particular episode progressed, Welby's demeanor got increasingly paternalistic. The warm and unconditional support he'd offered at the top of the hour grew far more firm, authoritative and some might say sexist.
I've taken the following phrases out of context, but they are exact quotes. Just imagine a physician today saying any of this to a patient:
"Now you listen to me…"
"If you can't make a mother's commitment all the way…"
"Don't inflict your half-way motherhood on him one more time."
These harsh words were in regard to Amy's anxiety about the well-being of a four-year old foster child she and her husband had taken in (as a result of some probably never realistic or legal matchmaking from Kiley).
Now, taking political correctness out of it and recognizing the times for what they were (again, I wasn't there, but I can try to wrap my head around it), it's clear the doctor's intentions were good. In the end, Amy responded to the insults just as Welby likely hoped--by standing up for herself and confidently marching into the boy's hospital room to commit to accepting him, allergies and all, as her son.
So, with this brief and fictionalized insight, I have a slightly better appreciation for the nostalgia expressed by Denver country doctors Robert and Michael Sawyer in this recent story from NPR. Likewise, I'm saddened by reports such as this one from NBC, in which Steven Levine, M.D., a Connecticut ear, nose and throat doctor, explains that the reimbursement rates are simply too low for him to accept health exchange insurance plans created by the Affordable Care Act.
I am relieved, however, to be a patient in the era of shared decision-making and team-based care. Despite the challenges (which are not insurmountable, in my opinion) of maintaining strong physician-patient relationships in today's healthcare environment, I'm glad I'm not at the mercy of one individual dictating what I do or don't do regarding my health or family.
Yes, there's more red tape, but along with it, more checks and balances that improve and save lives.
I wonder, 40 years from now, what we'll look back on and be grateful to have resolved. The era of the Affordable Care Act will certainly not be one that's easily forgotten. Is there anything about medical practices today that we'll someday miss? - Deb (@PracticeMgt)
