The Doctor Will See You Later

I gave my name at the front desk of my new eye doctor. “Check in around the corner,” said the clerk.

Two front desks, apparently. The secretary at the second one handed me some pages of demographics and medical history to fill out. In the meantime, she chatted with her associates as she scanned my insurance card.

I sat in the waiting room as instructed. After a short while, a young man called my name. Since the ophthalmologist is a middle-aged woman, I realized at once that he was someone else.

“Hi, I'm Jeff,” he said cheerily, ushering me into an exam room where he started to test my vision. (“What's the lowest line you can read? What's clearer—1 or 2? 3 or 4?”)

After a few minutes, I softened my voice and said, “Please don't be offended. But who are you?”

“I'm Jeff,” he explained.

“Yes, but what is your role here, exactly, Jeff?”

“I'm an ophthalmic technician,” he said. “The doctor will see you when I'm done examining you and dilating your pupils.”

He proceeded. In our time together, I learned a few things about Jeff. (I'm nosy that way.) Being an ophthalmic tech was his second career. His first was building custom furniture, “until I blew out my shoulder helping a buddy on a weekend.” Jeff's first eye job was in the cornea department of a teaching hospital, until slow business there limited his advancement options. So far he liked private practice. He tapped clinical data onto the computer screen to his left.

I returned to the waiting room. Shortly after, I heard my name again and through a dilated blur recognized the doctor herself. Her examination was businesslike, punctuated by more taps of data onto the screen. “You have early cataracts,” she said. “Not clinically significant yet, but they are there.” She said I didn't need new glasses unless I wanted a different style. “See you in a year,” she said, exiting. I made that appointment at the first front desk.

There are many aspects that go into a good or service. There are codes for diagnosis and procedure; these generate a fee. There are measures of efficiency and outcome aiming to streamline medical services, make them uniform, and lately, rate those who provide them. Much power and money are at stake, not to mention quality, now being energetically defined.

It's therefore understandable that for these and other reasons, many doctors delegate history taking to medical assistants, then counseling to other personnel. The doctor just comes in for the core service, the part that counts.

This seems a shame, for reasons I think go beyond sentiment, though maybe I'm fooling myself. (Without knowing the patient's background, level of motivation, and attitude toward the recommended regimen, how do you know he or she will follow it?) But larger forces at play outweigh objections like these.

Anyhow, in my own small clinical domain, I can still learn some personal things about my patients, and act as though it matters. After all, I've known many of them for a long time, some for decades.

My own internist of 25 years limited his panel and joined a national concierge firm. A colleague upstairs agreed to take me on despite a closed practice. Stan, in practice since the mid-1970's, is one of only three physicians who's been in my building longer than I have. He is quite a throwback. He has a small office, one secretary, and takes the medical history himself (no sheets). He even does his own EKG's, if you can believe it. But he does use e-mail and responds promptly.

You get the feeling that Stan actually knows who his patients are.

Stan is a vigorous guy, and he looks to practice another 5 years. Once he hangs 'em up, I figure I'll find a concierge of my own. Sometimes when you want intimacy, or its illusion, you just have to pay for it.

I gave my name at the front desk of my new eye doctor. “Check in around the corner,” said the clerk.

Two front desks, apparently. The secretary at the second one handed me some pages of demographics and medical history to fill out. In the meantime, she chatted with her associates as she scanned my insurance card.

I sat in the waiting room as instructed. After a short while, a young man called my name. Since the ophthalmologist is a middle-aged woman, I realized at once that he was someone else.

“Hi, I'm Jeff,” he said cheerily, ushering me into an exam room where he started to test my vision. (“What's the lowest line you can read? What's clearer—1 or 2? 3 or 4?”)

After a few minutes, I softened my voice and said, “Please don't be offended. But who are you?”

“I'm Jeff,” he explained.

“Yes, but what is your role here, exactly, Jeff?”

“I'm an ophthalmic technician,” he said. “The doctor will see you when I'm done examining you and dilating your pupils.”

He proceeded. In our time together, I learned a few things about Jeff. (I'm nosy that way.) Being an ophthalmic tech was his second career. His first was building custom furniture, “until I blew out my shoulder helping a buddy on a weekend.” Jeff's first eye job was in the cornea department of a teaching hospital, until slow business there limited his advancement options. So far he liked private practice. He tapped clinical data onto the computer screen to his left.

I returned to the waiting room. Shortly after, I heard my name again and through a dilated blur recognized the doctor herself. Her examination was businesslike, punctuated by more taps of data onto the screen. “You have early cataracts,” she said. “Not clinically significant yet, but they are there.” She said I didn't need new glasses unless I wanted a different style. “See you in a year,” she said, exiting. I made that appointment at the first front desk.

There are many aspects that go into a good or service. There are codes for diagnosis and procedure; these generate a fee. There are measures of efficiency and outcome aiming to streamline medical services, make them uniform, and lately, rate those who provide them. Much power and money are at stake, not to mention quality, now being energetically defined.

It's therefore understandable that for these and other reasons, many doctors delegate history taking to medical assistants, then counseling to other personnel. The doctor just comes in for the core service, the part that counts.

This seems a shame, for reasons I think go beyond sentiment, though maybe I'm fooling myself. (Without knowing the patient's background, level of motivation, and attitude toward the recommended regimen, how do you know he or she will follow it?) But larger forces at play outweigh objections like these.

Anyhow, in my own small clinical domain, I can still learn some personal things about my patients, and act as though it matters. After all, I've known many of them for a long time, some for decades.

My own internist of 25 years limited his panel and joined a national concierge firm. A colleague upstairs agreed to take me on despite a closed practice. Stan, in practice since the mid-1970's, is one of only three physicians who's been in my building longer than I have. He is quite a throwback. He has a small office, one secretary, and takes the medical history himself (no sheets). He even does his own EKG's, if you can believe it. But he does use e-mail and responds promptly.

You get the feeling that Stan actually knows who his patients are.

Stan is a vigorous guy, and he looks to practice another 5 years. Once he hangs 'em up, I figure I'll find a concierge of my own. Sometimes when you want intimacy, or its illusion, you just have to pay for it.

I gave my name at the front desk of my new eye doctor. “Check in around the corner,” said the clerk.

Two front desks, apparently. The secretary at the second one handed me some pages of demographics and medical history to fill out. In the meantime, she chatted with her associates as she scanned my insurance card.

I sat in the waiting room as instructed. After a short while, a young man called my name. Since the ophthalmologist is a middle-aged woman, I realized at once that he was someone else.

“Hi, I'm Jeff,” he said cheerily, ushering me into an exam room where he started to test my vision. (“What's the lowest line you can read? What's clearer—1 or 2? 3 or 4?”)

After a few minutes, I softened my voice and said, “Please don't be offended. But who are you?”

“I'm Jeff,” he explained.

“Yes, but what is your role here, exactly, Jeff?”

“I'm an ophthalmic technician,” he said. “The doctor will see you when I'm done examining you and dilating your pupils.”

He proceeded. In our time together, I learned a few things about Jeff. (I'm nosy that way.) Being an ophthalmic tech was his second career. His first was building custom furniture, “until I blew out my shoulder helping a buddy on a weekend.” Jeff's first eye job was in the cornea department of a teaching hospital, until slow business there limited his advancement options. So far he liked private practice. He tapped clinical data onto the computer screen to his left.

I returned to the waiting room. Shortly after, I heard my name again and through a dilated blur recognized the doctor herself. Her examination was businesslike, punctuated by more taps of data onto the screen. “You have early cataracts,” she said. “Not clinically significant yet, but they are there.” She said I didn't need new glasses unless I wanted a different style. “See you in a year,” she said, exiting. I made that appointment at the first front desk.

There are many aspects that go into a good or service. There are codes for diagnosis and procedure; these generate a fee. There are measures of efficiency and outcome aiming to streamline medical services, make them uniform, and lately, rate those who provide them. Much power and money are at stake, not to mention quality, now being energetically defined.

It's therefore understandable that for these and other reasons, many doctors delegate history taking to medical assistants, then counseling to other personnel. The doctor just comes in for the core service, the part that counts.

This seems a shame, for reasons I think go beyond sentiment, though maybe I'm fooling myself. (Without knowing the patient's background, level of motivation, and attitude toward the recommended regimen, how do you know he or she will follow it?) But larger forces at play outweigh objections like these.

Anyhow, in my own small clinical domain, I can still learn some personal things about my patients, and act as though it matters. After all, I've known many of them for a long time, some for decades.

My own internist of 25 years limited his panel and joined a national concierge firm. A colleague upstairs agreed to take me on despite a closed practice. Stan, in practice since the mid-1970's, is one of only three physicians who's been in my building longer than I have. He is quite a throwback. He has a small office, one secretary, and takes the medical history himself (no sheets). He even does his own EKG's, if you can believe it. But he does use e-mail and responds promptly.

You get the feeling that Stan actually knows who his patients are.

Stan is a vigorous guy, and he looks to practice another 5 years. Once he hangs 'em up, I figure I'll find a concierge of my own. Sometimes when you want intimacy, or its illusion, you just have to pay for it.