Front Porch: Doctor turnover shakes patient confidence in care

Where have all my doctors gone?

Here I am, in my 70s and, unfortunately, in need of more overall medical care and specialized attention than I used to, and my doctors are disappearing. They’re not retiring at a ripe old age (OK, one did, and one died), but mostly they’re just leaving – to do research, to teach, to go into administration or other related medical fields. And, I’ve noticed, a lot of them are only in their 50s.

Where is Dr. Marcus Welby when you need him?

There is the physician’s side to this story, of course, one I’ve learned a lot about as I’ve looked into this exodus and one I’m going to explore the next time I write on the subject (in two weeks), but for the moment, this is about me, the patient, and all of us patients who are feeling a little bit abandoned. Especially as we get older.

We gray-haired people do spend more time talking with one another – much to the dismay of our younger relatives, I’m sure – about what ails us, because these things take up more time in our lives. Or perhaps more time from our lives. But the reality is that we often need more medical attention (if we can afford it) to maintain ourselves. And we become more reliant on our physicians to keep the ship afloat and headed in the right direction – not just for disease diagnosis and treatment but also for the relationship and confidence that helps with our sense of well-being.

When we’ve built a relationship with our physicians, they’ve learned our stories. We are not just a pancreas or uterus or tumor walking into the room, we are the complex set of mind and body traits and issues that they know. And they have our trust.

It takes time to get there.

Of course I understand that things change. One doctor several years ago left her practice because her husband was transferred to another city. Another developed an illness that necessitated him limiting his practice. That’s life.

But what I’ve been observing firsthand for some time now is an increasing movement away from clinical practice. I see a gastroenterologist for a particular issue that requires some delicate maintenance. I’m now working with my third one in the past five years. Each time I have to reestablish and retell the history of what has transpired and how I got to this current state of balance.

In early July my primary care physician (in her 50s) sent out a letter notifying patients she will be leaving her practice in early August. She will be utilizing her medical skills in another aspect of the field. She is allowed to, but how long will it take for me to establish a relationship with another doctor who knows me, knows my story, without constant eye focus on the data on the computer screen?

There are no other physicians taking on new patients at the location where I have been coming for decades, where I saw another primary care physician before my current one joined the practice, where I know the women at the front desk, where I know the nurse, where I know people in the lab, where I know the good places to park and where I am confident I will be listened to and helped.

But the system she belongs to is large and there is a new doctor coming in September to one of the other locations across town from me, and my husband and I will try to establish there. I am aware that I am fortunate to have choices, but the choices aren’t plentiful, nor are they easy to navigate.

And what happens when the time comes when I – and all of us old folks – are perhaps addled or not so good at managing our lives in general, and now have to keep starting anew, over and over again? That’s an issue for another day, but if it’s difficult now, it surely will be more so then.

And, finally, my endocrinologist, significantly younger than me, sold her practice. Not sure what that was about. I needed to get a new one. First came the referral, which took time. Then an appointment was scheduled, for four months later. Then the appointment, which took quite a bit of the new doctor’s time, and which, thankfully, she gave me.

As the doctor, who I judge to be in her 40s, left the room, I tried to make a light comment about how I appreciated her careful attention and really, really hoped she wasn’t going to be retiring anytime soon.

With what sounded to me like a wistful voice, she said that more and more doctors are finding more and more difficulty with the health care system “and, frankly, a lot of us would rather be doing something else because of that.”

The thought flashed immediately in my mind: “She isn’t going to be around for long.” And I’ll have to start all over. Yet again.

If I may borrow a reference from “Star Wars,” I am aware that there is a great disturbance in the Force that is the medical profession, and, there is a lot being written about that, some of which I have been delving into recently. Plus, I’ve had a good conversation with a friend who is a physician in Seattle (she just entered her 50s), who has some good advice. More on that next time.

I do have sympathy for the doctors out there who care and who want to provide good health care. But as a patient, I have to note that this is getting hard. It’s hard to have confidence when I’m beginning to look at my doctors as short-timers, when it’s harder to be sure I’ve shared all the relevant things that will help the new doctor help me (because the nuances don’t make it into the electronic medical records, and it was the nuances that helped me to an important diagnosis once), when I am less flexible and able to adjust to ever-increasing changes, when I’m beginning to lack trust.

Wherever it is that my doctors are going, I want them to come back.