Over time, social and technological changes have led to changes in medical practice and the erosion of a caring ethic. Too many patients, the image of a doctor is akin to a Norman Rockwell painting of the kind, gentle, fatherly man who makes house calls, patiently holds hands and seems intuitively attuned to his patients’ needs. Doctors, too, identify with this image as a role model.
But the world of the modern doctor is far removed from this idealized picture. Societal and technological factors have created complicated and impersonal health care settings and experiences for most patients and physicians. What Rockwell did capture was a sense of caring and trust between physicians and patient which many people considered and still consider the cornerstone of both a good relationship and good medical care.
The medical care he was depicting, representing the medical care in the 1940s, was often conducted in the private realm of the home. Patients were born there, had children and illnesses there and died there. People survived serious ailments, infections and disease with little or no assistance from medical technology, or died.
Physicians could not offer effective treatments for most diseases but they did try to alleviate suffering and pain. Physicians treated illnesses of entire families and extended families and very often had long-term inter-generational relationships with their patients. By the 1980s, however, the Rockwell image no longer pertained. Few patients were seen by family doctors and few, even within the same family, were seen by the same doctor.
The family physician providing home care had faded away and the close and inter-generational relationships were lost. One explanation for the changes in medical practice is found in the scientific and technological revolution that has and is occurring at academic medical centers (“AMCs”). AMCs with their research facilities, their hospitals, and their medical schools are the primary location for change in medical practice.