Letters from Maine

Are you an optimist or pessimist?


“I’m fine. How are your kids?”


“They’re doing great, but we miss you. It hasn’t been the same at that group since you retired.”

I thanked her for her kind words. But the truth is that there were certainly physicians remaining at that practice who were at least as skillful and probably more caring than I had been. However, they were being increasingly challenged by an organization that struggled with how to be customer friendly and patient centered although it claimed to be both.

It must have been 8 years since I first met this young woman. She had just delivered her first child and was finishing her last year of family practice residency. In the nearly a decade since I had last spoken to her, she had worked in a couple primary care practices and was now the administrator of a rehabilitation facility. She described the all too common scenario of spending hours at home trying to complete her charting when she was doing primary care. Now she spends a good chunk of her time on the phone arguing with insurance companies trying to get coverage for her aging patients.

As she told me how frustrated she was with her current job and how pessimistic she was about the future of health care in this country, I realized that it wasn’t me that she really missed. I, and my old practice, are just examples of what primary care used to be.

Dr. William G. Wilkoff practiced primary care pediatrics in Brunswick, Maine, for nearly 40 years.

Dr. William G. Wilkoff

As I walked home from the grocery store after our encounter, I wondered how deeply I shared her pessimism. We mostly talked about how bad things have gotten now. But we didn’t talk much about where we thought the state of health care in the Unite States was headed.

Are you an optimist or a pessimist? To what degree will your answer to be colored by your career trajectory? Would you tell a young person that you think our health care system is so messed up that you would discourage them from becoming a physician because the work environment is becoming increasingly toxic?

Or would you acknowledge that health care in this country is going through a difficult time, but the potential reward of knowing that every day you have helped, or at least tried to help, someone is worth riding out storm?

For a moment, step back from your narrow focus as a health care provider. What would you tell a 40-something father of two children who is worried about what health care is going to look like when he is as old as his parents are now?

If you have come down on the positive side of this coin, where are the solutions going to come from? Is technology going to come up with the answers? Is a nationwide electronic medical record system that allows all providers to communicate seamlessly with each other a realistic possibility? Will physicians and patients eventually adapt to and accept a new reality in which health care providers are primarily technicians following algorithms generated by a team of scientists and payers?

Or will we continue to muddle along and hope that our system will get over the hiccups and arrive at some political solution? I am eager to hear what you think. ... and feel.

Dr. Wilkoff practiced primary care pediatrics in Brunswick, Maine for nearly 40 years. He has authored several books on behavioral pediatrics, including “How to Say No to Your Toddler.” Email him at pdnews@mdedge.com.

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