I am The Old Fish

Young fish are swimming in a river and come across an older fish. 

He says to them, “Morning, boys. How’s the water?” The young fish swim on, but after some time one asks “What the heck is water?”

As I continue to interface with younger physicians and trainees I am struck with how content and unruffled the majority of them are in today's chaotic (to me and my genre) health care world.

What seems disruptive and chaotic to the older fish is that many changes are transparent to the minnows.

At the start of my career  Medicare (1966) was just started, there wereno electronic health records, no HMOs, contracting with physicians was a questionable and frowned upon business model. There were many many diseases that were not treatable.  The life span of a child with cystic fibrosis was about 10 yrs. Professional advertising was considered unethical, and more.

There were no genomics, the understanding of DNA was in it's early phase. The idea of genetic engineering a distant gleam, stem cells were poorly understood and not yet clearly identified. There was no such thing as meaningful use, MACRA, MIPS, ACOs nor the affordable care act.

Today physicians swim in a sea of knowledge that almost seems a given, except for those who remember the 'old days'.

Perhaps the one thing that makes medicine so exciting and invigorating is the constant evolution and discovery.  However, it is a double edged sword.  The rapidity of change requires enormous energy to stay current and competent.

The old fish says lead on and the rest of health care follows. The new fish looks around, and is led by many non-physicians and/or regulators who have no knowledge of medicine other than a list of practice patterns and cost for treatments.  In a method counter to the old fish's training of treat the patient, first, worry about cost later, all fish now must add an entire new dimension to their treatment choices.

As the young fish now says to the old fish . "Tell me what it was like in the golden era of medicine?" And the old fish responds,  "I don't remember, but it seemed better, and a lot more fun!"

I don't remember hearing about burnout...I wonder why ?