In the Good Ol' Days People Just Died

Strolling into the former church social hall turned provider office area a fairly intense conversation was taking place as Doc Conway explained to Rebecca, our nurse practitioner, "Back in the good old days, people just died." Perhaps some context is needed here.

The townfolk of Wynoochee used to see the town doctor for straightforward issues. You break your leg working in the woods there is no question what the problem is. Contract typhoid and there are only two outcomes--you get better or you die. The most common reasons people went to see the doctor was injury or acute illness with clearly defined problems, perhaps a limited number of treatment options, but you knew when the course of the illness had been completed one way or another.

Modern medicine has stolen this clear endpoint from the physician. The success of vaccines and sanitation has decreased the amount of infectious disease compared to days past. Modern medications help blunt, but not cure pathologic processes going on in our patients bodies. What we are left with is a constant state of disability. Often this disability is self induced, of course, through smoking, eating crap, and being couch potatoes. The goal of the modern primary care doctor is not to cure, but to keep stable and minimize disability.

Rebecca had begun this conversation with Doc complaining she never actually made anyone better. The ARNP pulled out her schedule for the day filled with patients with diabetes, high blood pressure, COPD, fibromyalgia, and depression. It was painfully depressing just looking at it. Just every so often she wanted to actually fix someone. There's a concept. You get to the doctor and you get better. You get completely better.

After the old time physician reminisced over the good old days he searched his memory for something he did that day in which the patient left the office feeling better than when he or she came in. "A thrombosed external hemorrhoid. Treat a patient for an acutely thrombosed external hemorrhoid and you'll have a loyal patient for life."

Ahhh, the glamour and glory of the job.