I have to say I'm absolutely struck by the heartfelt comments on my post about Hank. So I'm wondering, was Hank a dinosaur?
That is, he was in private solo practice. He was with a couple of groups before he went solo - don't know what the story was there, but he finally found himself in a small office by himself and had never been happier. Nothing between him and his patients, except insurance, but he didn't grouse about that.
Medical sociology, mostly Eliot Friedson in his great tome Profession of Medicine, looked at groups of doctors, mostly large groups in New York. He said that the more you are in a group, the more you look for consensual validation from your peers - that is, other doctors - and the less you look to your patients to validate your work and you as a person. I would imagine that the more administration there is, the more you look for validation from the administrators, the more you want to be like them (every doctor I know thinks that administrators have a sweet deal - little do they know). So with larger institutions patients are less patients and the more customers or even consumers.
Maybe I'm wrong. Maybe when a Kaiser doctor leaves the scene for whatever reason, patients feel bereft. Or maybe they shouldn't feel bereft, so personally deserted. Maybe they should feel that there is another one just behind him or her, waiting to take their place. I remember in Sweden when I would talk to people about the impersonality of the polyclinics, some of them said, but isn't that what you want, objective opinions?
But for myself I can't think that medicine should be anything but a real person to person enterprise. Our group, Bayside, is large by Bay Area standards - about 35 clinicians in 10 offices. But the offices are small, intentionally, not one stop shopping but rather pearls on a string. I think my job is to make sure we retain the ideals that Hank personified. We'll see if it's possible - I think it is. The culture comes from the top, they say, and I think everyone knows where I stand. With the dinosaurs.