Editorial
"Just You and Me"
By Brien Seeley, MD
One hot summer day, when I was a boy of seven, Mom sent me out to help
Dad build a big rock wall in the front yard. “It’ll be just
you and me today,” Dad said. “We’ll build it together.”
I knew this would be my special, private time with Dad, when he would
teach me important things about grown-ups’ jobs and being a man
and stuff. I knew we would share the fun, the challenge, and the pride
of building that big wall, “just you and me.”
In that huge pile of rocks, each one was different. My job was to find
the right shapes so Dad could cement them in place. After a while, Dad
paused, let out a big sigh, wiped his brow, and looked deep into my eyes.
He said, “Son, whatever you do when you grow up, no matter what,
get a college education so you can be your own boss.”
Such poignant and memorable moments only happen when it’s “just
you and me.” Working on that rock wall ended up giving Dad lots
of “just you and me” time with my brothers and my sister.
The whole family was proud when the wall was finished. And all of us kids
did go to college.
My sister, Barb, recently took a sentimental drive by our old house and
found our once-beautiful rock wall demolished into rubble. The edifice
had stood for decades, keeping its personality through downpours and earthquakes.
It would soon be replaced by a reinforced concrete monolith. Barb stopped
her car and put one of the old rocks in the trunk. We later inscribed
the rock with the phrase “just you and me” and placed it on
Mom’s fireplace hearth as a remembrance of Dad.
During the 1980s, private practice was my rock wall—strong, trustworthy,
and supportive. I spent my days in “just you and me” time
with patients in the exam room, sorting through their problems and piecing
them together like rocks of different shapes. These sessions were often
poignant, private times between doctor and patient, when important things
were memorably taught. Physicians in private practice were proud, respected,
sovereign individuals, each with his or her own work hours, personality,
and devotion to patients.
But my rock wall may be demolished too, and be replaced by a faceless
concrete monolith. Being your own boss as a physician is no longer a “just
you and me” endeavor. Today, we have HIPAA, pre-authorizations,
e-claim regulations, utilization monitoring, pay-for-performance, E&M
coding, PBMs, the MBC, and Cal-OSHA, among other requirements. Evidence-based
medicine and its computerized “decision support” will soon
obligate us to use rigid, unthinking treatment regimens. Our diplomas
on the wall are being gradually replaced by mandatory posters that depict
the tedious details of workplace regulations. Such intrusions affect both
private and salaried practitioners and often strain and conflict with
our culture of caring.
The U.S. Supreme Court has endowed corporations with the rights of people
and allows them to be treated as individuals, even though they have no
soul, morals, or innate sense of caring. As Joel Bakan wrote in The
Corporation, “Corporations dictate the decisions of their supposed
overseers … and control domains of society once firmly embedded
in the public sphere.” When I’m sick, I want to count on a
real person. Counting on a corporation leaves me worried.
Future patient care may consist of having a wand waved over your body
that simultaneously scans with MRI, CT, ultrasound, oximeter, and PET,
while a personalized genetic and chemical analysis is made of the tiny
finger-stick blood sample that is automatically plucked from you. There
will be no doctor feeling your belly with warm hands, listening to your
chest, or gently holding up your fingers. Your diagnosis will be delivered
like a fortune cookie, without consolation or a hand on the shoulder.
Will we regret that loss? I think we will. When asked “How are you?”
everybody wants to see that “just you and me” feeling in the
eyes of their physician. As cold economic forces impel us toward providing
care with teams and technicians instead of an individual practitioner,
with computers instead of with our minds and hands, we need to remember
the value of “just you and me.”
Dr. Seeley is a Santa Rosa ophthalmologist in private practice.
Sonoma Medicine, Volume 56, Number 2 (Spring 2005).
