I was not content to retire at age 65 like many of my contemporaries, some who exited medicine even earlier. Still, I couldn't resist the buy-out package my employer offered me when I turned the golden age. The problem I faced was not that I was suddenly retired; rather, it was that I hadn't retired into anything.
Left jobless, I thought long and hard about my next move. My only prerequisites were that whatever new work I undertook, it had to be portable so I could travel and visit my grandchildren who were scattered from the east coast to Hawaii with a stop in-between. My "encore career" had to be virtual and not involve direct patient care, not even via telehealth. I found it in the form of a collaborating physician -- a physician who supervises advanced practice providers (APPs: nurse practitioners or physician assistants) because their states' regulations require it.
The responsibilities of collaborating physicians vary from state to state and usually involve chart review at a minimum. I suppose reviewing the charts of APPs is considered a good proxy for evaluating their quality. However, I insist that in addition to reviewing charts, I talk directly with APPs and discuss their patients -- similar to conducting "curbside consultations." They're quick and easy and give me a much better sense of the qualifications and expertise of the provider.
"Oh, Dr. Lazarus, you're so old school," I've been told.
What does it mean to be "old school?" A baby boomer? Educated before the era of computers and PowerPoint? Attended classes in person rather than virtually? Charted hand-written notes before the advent of electronic medical records? Looked at patients rather than computer screens? Listened to their stories? Probably all the above -- and more.
an internal medicine physician and health and lifestyle coach, seven fundamental traits of old school physicians: attentive, not rushed, thoughtful, clinically astute, personally connected, independent, and technologically unchained. I believe old school values still appeal in modern medicine; patients and families seem to desire these qualities in physicians. In addition, strong physician-patient relationships promote .
I'm proud to be an old school physician, even if the term "old school" carries a negative connotation. is a physiatrist and pain specialist who touts the benefits of being old school on his . He notes that in many cases, old school medicine affords him the time to do a detailed history and physical examination and correlate signs and symptoms without the need for extensive laboratory and imaging studies.
Dhand states, "The old school physician has the diagnosis in mind right after talking to and examining their patient." That explains why I insist on personally supervising APPs -- I'm more interested in how they treat their patients than how they . Given that about half of the total text in the medical record is text previously written about the patient, chart review is a waste of my time. Duplication also makes me doubt the veracity of the information in the medical record.
The essence of my interactions with APPs is making sure they have captured the chief complaint, taken a full history (±physical exam for psych patients) including family and social history, and conducted a thorough review of systems and a mental status examination. I want to hear about the diagnosis, differential diagnosis, treatment plan, and response to therapy. You know, old school.
, "Every generation throws a hero up the pop charts." I find it more telling that every generation seems to consider the previous one "old school." The classic textbook was written for young doctors by the scholarly physician . The textbook contained "worldly wisdom," according to of the book in JAMA. Here's a revelation: the book was published in 1936, when Johnson was around 50 years old. The "young physicians" were probably half his age. Old school doctoring has been around a long time, always marked by generational gaps.
During medical school, some of my classmates ridiculed a senior attending physician whom they considered old school. He wore a bow tie, mumbled and fumbled his way through the hospital corridors, and always seemed to be in a hurry. The attending ran a busy outpatient practice in internal medicine, made house calls, and rounded on his hospitalized patients. Medical students considered him a dinosaur.
But the attending also taught us and conducted research, fulfilling the . "Where does he get the time and energy to do all this?" students wondered. When Dhand encountered an old school physician, he a more incisive question: "How have we got to the stage where a genuine and caring doctor has become the odd one out?"
I think I know the answer.
The attending remained steadfast to his patients. They loved him and stuck with him for decades. The attending was versatile and efficient. Contrary to the stereotype of the old school physician who has let their knowledge lapse and lost their clinical skills, this attending was brilliant. In fact, he was the director of our continuing education department.
It was my supposition that the medical students feared they would not measure up to the attending once they became practitioners themselves, so they felt compelled to put him down. They mocked him by joking that every one of his chart entries read the same -- "as above, see below" -- in reference to the attending's heavy reliance on the house staff for the overall management of his patients. Rather than view the attending as a role model, he was vilified and marginalized for his seemingly old school ways. Yet, there was nothing about his thinking that was out of step with the times.
The use of pejorative terms like "old school" has its origins in . Labeling a physician "old school" compensates for trainees' insecurities and feelings of inadequacy. It's a riff from an old theme so eloquently explicated in -- the desire for connection foiled by ageist (and other) assumptions that drive people apart. Sharing memes poking fun at the elderly only deepens divides.
While visiting my daughter (the one who lives "in-between"), I related a story about someone close to us who got lost driving to the supermarket. When I tried to give this person the correct directions after the mishap, they got angry at me. "You were mansplaining," my daughter said. To her surprise, I knew at once what the term meant, and I responded, "I may be old school, but I'm not outdated."
Arthur Lazarus, MD, MBA, is a member of the Physician Leadership Journal editorial board and an adjunct professor of psychiatry at the Lewis Katz School of Medicine at Temple University in Philadelphia.