Going to the doctor in the "Golden Era"?

[HepKitty]

Dying rooms are mentioned in Erich Maria Remarque's All Quiet On The Western Front (1929). After being wounded in a WWI battle, the protagonist recuperates in a Catholic hospital. He shares a room with several other wounded soldiers, and all of them dread being sent to the dying room. When the nuns come to move one of them to the dying room, he becomes hysterical and violent because the move signifies their loss of faith in his recovery.

I just saw that a couple weeks ago. Very disturbing and sad. Good movie though

 

[virgi]

my grandfather was a practicing physician in los angeles from the early 30s till about '72 when medicaid/medicare came into existence. All I can tell you is that his favorite thing to do was to tell expectant mothers the sex of their child and write something different on the chart. So if they came back to him saying "Dr. you told me I was going to have a girl, and I had a boy!", he'd say "no I didn't tell you Mrs. so and so that you were going to have a girl, you see I wrote boy on the chart". He used to make housecalls, etc. He used to also carry liquid cocaine as an anesthetic. We were stupid and got rid of all his old medical books years ago, we were smart enough to save the oldest gynocological book printed in the united states which we still have.

 

[LoveMyHats2]

I agree with what you are saying here. I recall our family doctor whom lived around the corner from our home at the time, coming to do the house call instead of having to go to his office for a shot or whatever was needed. I think to some degree, hospitals have become so much more a business than what they used to be. There is one particular hospital that I know of that advertises as a "non profit" organization, yet in reality they are on the open market stock exchange and have locations all over the state. Now I am not saying there is anything wrong with what they do, I just always chuckle when I see their advertising they are "non profit" because they are making a bundle.

 

[HepKitty]

I agree with what you are saying here. I recall our family doctor whom lived around the corner from our home at the time, coming to do the house call instead of having to go to his office for a shot or whatever was needed. I think to some degree, hospitals have become so much more a business than what they used to be. There is one particular hospital that I know of that advertises as a "non profit" organization, yet in reality they are on the open market stock exchange and have locations all over the state. Now I am not saying there is anything wrong with what they do, I just always chuckle when I see their advertising they are "non profit" because they are making a bundle.

a bit OT here

Yes and no. I worked at a hospital for 3.5 years and found out some interesting things. This one in particular used to be owned by the county but a CEO squandered the millions in the bank (stupid expensive contracts with companies owned by his drinking buddies, overinflated salary, etc), an expansion not in the budget, etc. So the county sold it to a for-profit company, who did fund the $220 million expansion (looks like a hotel seriously), and now they're trying to sell it. Big business? Oh yeah, big frivilous business.

I was just getting into the financial side when my job packed up and moved to India without me. I was horrified to find out that insurance companies have contracts with providers, and those contracts only force the insurance companies to pay a percentage of the total cost. Some ICs only pay 30% of the total bill, the patient pays 20%, so that leaves half unpaid. No wonder the costs are so high. They have to be because they have costs to cover and ICs are pretty much off the hook in terms of responsibility.

If anyone ever gets into a self-pay situation, ask the billing department if they will haggle a bit if you make a one-time payment. ICs get discounts why shouldn't we?

 

[LizzieMaine]

I had a situation where I had to have a minor surgery, and had no insurance at the time. They quoted me $2500 or so for the total cost, and I mentioned that was going to be kind of rough on my budget, and they said, "well, we can knock it down to $2000."

And my thought was "what am I doing here, buying a used car?" When you have to haggle for your health care costs like a trader in an Arab bazaar, then there's something deeply twisted and sick going on with the system.

 

[HepKitty]

When you have to haggle for your health care costs like a trader in an Arab bazaar, then there's something deeply twisted and sick going on with the system.

I agree completely. But it is what it is, may as well learn to play along and save yourself some money.

 

[Tomasso]

As far as Golden Era medicine is concerned me thinks it was sorely lacking, especially where surgery was involved. In the early 70s a relative who was a surgeon/professor back in the day told me that at that time 90% of surgical procedures were invented during WWII. Funny that a war actually served to benefit mankind............

 

[george]

Well, battlefield medicine is very valuable to an army. The first "ambulances" were set up by Napoleon to remove his wounded from the battlefield. Of course on a battlefield you have different considerations than you do in the civillian world (you're less worried about tweaking a wounded soldier's potential c-spine injury and you're more concerned with getting him and yourself behind solid cover--it's rare to move a trauma patient in the civillian world, even in EMS, if you haven't provided for some kind of spinal stabilization), but I'd imagine that surgical techniques shouldn't be very different whether they're being performed by the military or by a civillian, so that makes sense, Tomasso.

The reason for the huge difference in hospitals these days vs. hospitals way back when is probably the fact that hospitals today are almost exclusively run for profit, as you guys have pointed out. The thing is that they all (or almost all) used to be run by donations, and yes, the church played a larger role in them.

On the one hand, running the place for profit encourages healthy competition (both between hospitals and between doctors) and probably makes hospitals better from a purely technical standpoint. But a huge complaint with the health care of today is that people don't feel like they're being treated as people but rather as a case, a number, a sickness. Perhaps the overall view of the patient gets lost in excessive competition, I can't say for sure. But I hold a holistic view of medicine and hope to avoid treating patients like that in any future career in medicine that I might hold. In fact, I think I would enjoy being the "old school" family doctor, going around making house calls, but I could also see myself as a hospitalist.

 

[Shangas]

Dad's been freaking out about my blood-pressure.

He purchased one of those electronic digital blood-pressure monitors to check both our pressures and mine was apparently shooting through the roof.

This morning, we went to our family doc., who also happens to be a very close family friend (We've known him 30+ years). Apart from suggesting we should all gather our families together and go out for dinner sometime soon (yum!), he checked my blood-pressure the old-fashioned way.

I'd love to say that he whipped out a doctor's chronograph...

...put his finger on my wrist and just checked the time. But he didn't go quite that golden-era'y.

He used one of those oldschool hand-pumped blood-pressure monitors with the mercury pressure-guage. And my pressure came up as normal. A teensy bit high, but within the accepted healthy zone.

I asked him why he did it the old-fashioned way and didn't use a modern digital monitor.

In his own words: "Gravity never lies" and "the mercury is much more accurate". The golden-era blood-pressure monitors with the hand-pumps and the mercury guages, while they might take a bit longer to operate, give much more accurate readings than modern digital ones. That's why he still keeps it in his office. My pressure hadn't changed since the last time I saw him a few months ago.

 

[amador]

I recall having our family doctor pay a house visit because my mother could not get to his office. I remember that he was dressed in a black suit and hat and placed his black medical bag on the dinner table. I saw all of this from the floor where I was lying, sick. It was about 1954. I went to medical shcool in 1996 and expected to go into private solo practice. By the time I graduated in 2000 the advice was to jin a private group of about 4-5 physicians. By the time I got out of residency in 2006 the advice was to join a larger group of physicians that worked wor a larger clinic or a hospital. During medical school I was trained to do clinical and hospital medicine. In residency I was trained to do clinical and hospital medicine but was introcuced to the concept of Hospitalists. Now I only do outpatient medicine for large organizations and leave the hospital work to those that want to do that type of work.
In the old days, Golden Era, a Doctor did everything. Some of my attending training physicians were in practice during that time and they are like giants in their communities. They delivered babies, performed surgery, took care of trauma and attended to those in the hospital. They were wise advisors and role madels. Now even the Generalist Family Physician is a specialist. We are employees and behave like employees.
Sorry about the rant. Just thought I would provide some perspecive.
Of course medicine is much more complex and its delivery more problematic. We used to kid our elder attending doctors by saying that during their day there were only six medications to remember and heroin dosen't count.

 

[Atomic Age]

I'm late coming to this conversation, so forgive me if some of this has already been covered.

My parents started having kids in the late 1950's. At the time my Dad worked for Air Research, a large aerospace manufacturer, now known as Honeywell. Through his job my parents had some of the best private health insurance available at the time. But things like going to the dentist, seeing the eye doctor, or having a baby were just not covered. In fact when my parents knew that my mom was pregnant, they would save for the next 9 months to pay for the hospital.

Of course in those days, there weren't all the specialists and all the fancy machines that they charge you extra for. Did didn't do all the testing that they do now. At that time a women going into the hospital to have a baby would probably only see her obstetrician, and MAYBE her family doctor. But the fact of the matter is that today, a little over 50% of what you spend on health care, goes to processing the insurance. The majority of the staff in a hospital are there at least in part to handle insurance paperwork, or to deal with the insurance companies. Insurance is exactly why medical care is so expensive these days.

Interestingly, there are now groups of doctors who don't take insurance at all. They charge MUCH less for an office visit and they keep more of the money that you pay themselves, rather than it going to an insurance company. Folks going to see these doctors have dropped their health insurance, and rather than paying premiums, they put that money into a special savings account, that is just for health care.

Doug

 

[Atomic Age]

I had a situation where I had to have a minor surgery, and had no insurance at the time. They quoted me $2500 or so for the total cost, and I mentioned that was going to be kind of rough on my budget, and they said, "well, we can knock it down to $2000."

And my thought was "what am I doing here, buying a used car?" When you have to haggle for your health care costs like a trader in an Arab bazaar, then there's something deeply twisted and sick going on with the system.

As soon as you tell them you don't have insurance, suddenly the whole procedure costs them less, so they can cut you a deal.

Doug

 

[amador]

Doug, administration has already cut a deal with the insurance companies and they are willing to cut a deal with you. The insurance company got their break and now admin is trying to give you a break. Sorry, no puns intended.

 

[Angus Forbes]

I remember seeing a prominent Baltimore ophthalmologist negotiate the price of his services with an impoverished-looking elderly lady, circa 1958. The Doctor said something like "what can you pay me?" The lady said two dollars was about all that she could afford. The Doc said "fine" and thanked her. He was a good man!

 

[Atomic Age]

Doug, administration has already cut a deal with the insurance companies and they are willing to cut a deal with you. The insurance company got their break and now admin is trying to give you a break. Sorry, no puns intended.

Actually the insurance companies tell the Hospitals what they can charge for a particular procedure. The Hospital either charges that or they don't get paid. The reason they can cut a deal with you if you DON'T have insurance, is because they can cut out all of the staff people who have to deal with that insurance, so the whole thing costs them less than it normally would.

Doug

 

[Stanley Doble]

This might sound like a daft question, but how was something as simple as scheduling a doctor's appointment done? Was there an equivalent to the health insurance that most people have/don't have nowadays, or did you just pay whatever the doctor's fees were?

What about paying for operations?

Although I lived as a child in the US, I don't remember much. I do remember seeing our family GP, an elderly man who's surgery was actually in his house.

I can recall a shift in the '80s after our GP passed away, when we had to go to a new doctor in a medical centre, and the term "co-payment" started to appear.

I asked my father, however he doesn't remember (?!?!).

I grew up in small town Canada in the fifties. At that time our doctor worked out of his house. You phoned him up and he made a house call the same day, after he saw the patient would make follow up appointments as he saw fit. This would take the form of " Keep him warm and give him this medicine, if he turns blue and stops breathing call me, otherwise I will see you tomorrow morning" type of thing.

The doctor's office hours were in the afternoon. Starting at a specific hour, 1 or 2 I think, and ran until he saw the last patient. Everyone took a seat in the waiting room and waited their turn, for hours if necessary.

If you were well enough to drag yourself to the doctor's office that is what you did. House calls were only for the very ill.

My father had medical insurance through his employer. I don't know if it was a free fringe benefit or if they took the money out of his pay check, a little of each I suspect. In addition he bought Blue Cross or Green Shield medical insurance. This paid for things the regular insurance didn't including a semi private room when I had my tonsils out. It cost $35 a year for a family of four.

Doctors looked like doctors in those days. They wore a suit and tie, in their office they would hang up the suit coat and put on a white coat like in the movies.

Around 1980 they started dressing like they were going to play golf. Now they dress like they are going to rake the leaves. Possibly because they are no longer professionals, they don't feel they have to look like professionals.

Do you know what a professional is? Someone who doesn't answer to a boss. He answers only to his clients (patients) and professional peers.

Back then they were professionals. Now they are low level bureaucrats. That is how they look anyway.

 

[Stanley Doble]

Might add that our family doctor in those days, a middle aged man, inherited the practice from his father and passed it down to his daughter. Three generations of doctors in the same family living in, and practicing medicine in the same 1870s house. Although I don't think the present doctor works out of her house, or makes house calls. All that went out in the seventies.

 

[amador]

I went to Medical school at age 44, graduated from residency 2006. Like I noted previously, I an an employee and act like an employee. I am a very valuable Commodity to my employer. I have a contract and have essentially allowed somebody with an MBA to make money off my medical credentials. I take a shower every day.

 

[Stanley Doble]

I went to Medical school at age 44, graduated from residency 2006. Like I noted previously, I an an employee and act like an employee. I am a very valuable Commodity to my employer. I have a contract and have essentially allowed somebody with an MBA to make money off my medical credentials. I take a shower every day.

I hope you respect your trade enough to dress nice and don't lie to your patients any more than you have to (it can have serious consequences - for them).

I won't ask you to respect your patients because that would be unprofessional.

 

[amador]

The obstacles i have to overcome to be able to pactice medicine and for the privilage of helping someone are formidable. Compromising some of my ideals for the benefit of my patient seems to be the norm. Some of my patients do not want to hear the truth, some have actually complained that i have revealed reality, they would rather take a pill. The truth doesn't set men free, it just annoys them. I wear a Fedora, 'nuff said.