The difference between care and service is significant

My father, recently retired, spent over 40 years in private practice. After dinner, he would sift through piles of paper charts and call patients with their lab results. As a grade schooler, what impressed me the most was that he knew many of his patient’s phone numbers by heart. Of course, this was in the days before HIPAA and caller ID, so scattered charts on the dining table and calling patients from the home phone was just the way he did business.

The point of this story is not to bemoan the current state of medicine, where it feels like doctors spend 75 percent of their time battling with the electronic medical record, 15 percent of their time battling with insurance companies for authorizations, 10 percent of their time apologizing to patients for running late, 10 percent documenting patient-care hours and another 10 percent of their time actually providing the kind of care they went to medical school to provide. (Wait, does that add up to more than 100 percent? You get my drift.)

No, the point is to figure out how to provide the kind of care old-school doctors could provide in the current environment. When my father was starting out in practice in the mid-1970s, his mentor advised him that patients want three things: availability, affability, and ability (in that order). Even then, the tension of service (availability and affability) over care (ability) existed. But what happens when availability and affability trump ability? Where I was a cardiology fellow in the early 2000s, there was a floor of the hospital reserved for important people with shiny wood laminate floors and afternoon tea.

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