Transactional vs. relational medicine

My father graduated from the University of Illinois Medical School in December of 1943. At that time medical school was shortened from 4 years to three years in order to produce more physicians to assist in the efforts of World War II. He had grown up in a family of poor Italian immigrants. Because he had rheumatic fever as a child which left him with a weakened heart, he was not able to perform physical work like his brothers and sisters. So the family worked together to send him to college and then medical school. The curse of rheumatic fever became the blessing of a medical career.

My father modeled what it meant to be a physician. It was not a career it was a commitment. A commitment to the people who entrusted their health to you. A commitment that meant you put the interest of the patients before your own. Fiduciary is the term that defines this relationship. It is a word and a concept we are losing in the culture at large and medicine in particular.

Physicians put the interest of their patients before their own by their willingness to go into the hospital at all hours of the day or night when their patients needed them. They made medical recommendations based on the patients’ interests and not their own financial interest. They took phone calls from patients at all hours to be responsive to their needs. “Work life balance” was not in the physician’s lexicon – your work was your life.

Today, society and medicine are becoming increasingly transactional (good and services in exchange for payment) and less relational (acting as a fiduciary because of caring for the people you are serving). Competence is offered but not necessarily a caring relationship. Physicians are becoming like airline pilots. They are highly trained, highly skilled and perform an important service. You literally put your life in their hands when you fly. They are paid to fly you safely to your destination in exchange for your airfare. They don’t need to know or care about you or why you are flying. They are paid to deliver competent service.

I mourn to see medicine going down this path. In many organizations you see the “available provider” and not your personal physician. You are care for by hospitalists rather than your physician caring for you in the hospital. There are many benefits to hospitalists so please do not read this as being critical of their sincere service. But it is just to underscore the movement away from relation-based care to system-based transactional care.

I am closing my private practice in Wasilla due to personal health reasons. I am broken hearted to leave behind the patients who invited me into their lives and entrusted their health to my care. I forged a relationship with them and made myself available to them not because it was convenient but because it was what my father taught me to do through the example of his life.