Editor's Note
Personalized Medicine
“This is my doctor, Chuck Meyer,” my fellow church member said as he introduced me to a visitor. As he went on with an inflated assessment of my professional prowess, I started feeling a bit uneasy about that phrase I had heard so many times, “my doctor.” Suddenly, it seemed to have an aura of possessiveness, suggesting a kind of ownership that means “I can call you in the middle of the night” or “I expect you to listen to my entire list of problems when I visit your office” or even “I expect a response when I corner you in the church common to request a prescription.” I politely sidled away from the conversation wondering whether some no-trespassing boundary had been crossed and whether I wanted to be “my” anything to anybody but my family.
“My doctor” is a well-worn phrase that speaks of a relationship nurtured over time and that reflects a patient’s sense of connection to a doctor. It also implies that the doctor should respond like this: “As your doctor, I know you. I care what happens to you.” That relationship has been the cornerstone of the practice of primary care, and that relationship may disappear if primary care withers.
The forces threatening primary care are economic and practical—with astronomical medical school debt confronting disparate earning potential in medical specialties and 25-patient-50-phone-call days losing out to procedure-based practice. The evidence for primary care’s disappearance is mounting: stagnant or declining applications to primary care residencies, primary care groups searching for years to find a new partner, and individuals making call after call to find a primary care physician taking new patients. Our group of four internists has found the search for a partner to be like hollering into an empty tunnel. My son, healthy, insured, and 26, tried four family practitioners in San Francisco before he found one accepting new patients. Staring my 60th birthday in the face, I wonder who will take care of me as I head into the age of pills and patienthood?
With the advent of hospitalists, doctors finishing internal medicine residencies now have a third alternative to primary care or subspecialty training. Hospital medicine offers attractive salaries and defined hours, so residents are flocking to those job openings, leaving the pool for primary care practice even smaller.
The future of primary care may not be all dark. The concept of the medical home may rejuvenate the ranks of practitioners and resuscitate the specialty. And our sampling of physician opinion yielded many hopeful comments.
Like most areas of medicine, primary care won’t be the same in 10 years. Perhaps the electronic medical record will fulfill its promise and make quality practice easier. Perhaps we’ll use more physician extenders. Or perhaps we’ll all have to accept the hospitalist model. Whatever it looks like, I hope we primary care doctors still can establish a relationship with those we treat. Despite getting cornered at church, I like being “my doctor” to my patients.
Charles R. Meyer, M.D., editor in chief
Dr. Meyer can be reached at
cmeyer1@fairview.org