I recently found myself walking along the streets of Edgartown, Mass. The town, an old whaling port on the island of Martha’s Vineyard, was my home for the summers of the mid- to late-1960s. I had been back only a few times since, but was amazed as I walked within the shiny aura of the village. Each house on the streets surrounding Main stands on property now worth in excess of $1 million. The houses looked the part, each with what seemed to be a fresh coat of paint, and many surrounded by flocks of gardening teams spreading mulch and ensuring that flowers and bushes were all properly tended. The result is a town that looks as if it would be right at home as a movie set—so perfect as to appear fake.
I walked along the street toward my old home. One house stood out; it had always been especially run down, but now it looked perfect.  Some of the Victorian design features that I vaguely recalled appeared to be missing. Something wasn’t right, and I later asked a cabbie about the home. “You’re right,” he said, “The original house was torn down a few years ago. This is actually a brand new house on the same footprint. It’s not as nice, but they sure keep it up now, don’t they?”

I finally got to my old house. The grass was poorly maintained. A clothes line reamained in the backyard, giving away the lack of a clothes dryer in the house. The driveway, rather than being brick or well-manicured pebbles as in surrounding houses, remained two ruts in the lawn. I imagined I could see an outline of where my old vegetable garden was. I walked up the porch and knocked on the door. A pleasant woman in her mid-80s stepped out and I introduced myself. She asked after my parents, as it was the daughter of the woman from whom we had rented the house decades before. I gazed inside: the wallpaper and furniture was all as I remembered it. She told me how all her neighbors, old friends all, had moved away. She could barely afford the property taxes on what used to be an easily affordable home. Even if she could afford it, she found paying $50/hour to gardeners absurd when the grass, bushes and trees all look so nice in their natural state. Indeed, that home looks now the way the entire town did back when I called it home.

And Main Street itself, she pointed out, is now home to shops catering to tourists, rather than to newsstands, grocers and other stores that earned their income from the workers who lived nearby. Only a single store, a hardware store from the 1940s, remains on Main Street. The rest were built in the 1970s or much later. The town is picture post card perfect, but no longer appears to be quite right. It’s not a working town anymore but is a representation of what such a town might be, given amazing sums of cash.

I left Edgartown feeling sad, with something of a “you-can’t-go-home-again” sense, and with concern for our family friend who finds herself growing older in the home she was born in, but in a town that is no longer her town.

My personal physician has a small office in which he works as a solo practitioner. We sit in his office and talk before he examines me. He reviews the EKG and the urinalysis and then we sit and talk some more, discussing various health-related issues. He often jots some notes on a blank sheet of plain paper. On my way out the door, I write a check to pay for the visit. My doctor has known me since 1970 or so. I don’t have to remind him of my personal or medical history. He barely has to check his notes, but if he does, there are only a few pages that he would need to review. As a result, I spend my time there in actual conversation, not watching him as he interacts with a computer screen or pages through sheet after sheet of useless treatment plans or other policy-driven paperwork that an “efficiency expert” in government feels is an important part of the medical record.

I worry that my medical care is turning into the world of the past—that the comfortable ruts in the driveway will be replaced soon by expensive bricks. On the few occasions when I’ve needed to go to another doctor, I often find myself in decorator-designed waiting rooms. Halogen lights shine down on movie-set like versions of what doctors’ offices might look like if there were a few extra tens of thousands of dollars hanging around. Computers glow in each room, and I never know which clinician is going to see me. I do know one thing—whomever walks in won’t know me. They’ll spend more time with the chart than they will talking, more time with the insurance-related paperwork and medical codes than with the actual work of formulating and diagnosing, and I’ll end up feeling like I did in New Edgartown—sad about the loss of what was, and how so often we find ourselves as a society moving in a direction that seems inevitable even as it departs from the sane, the comfortable and the inexpensive.
In the coming decades, we will see a rapid move toward guideline-oriented medicine, where people will be treated as if on a production line, each one treated according to evidence that is based on population norms, all as ensured by enforcement of quality measures and electronic reviews. The days of individualized healthcare are drawing to a close. The bushes will all be neatly trimmed, the grass uniform, but the feeling will be impersonal and cold. Is this really the road we wish to take?

Stuart Gitlow, MD, MPH, MBA, a psychiatrist, is a member of the American Medical Association’s Council on Science & Public Health, and an officer of the American Society of Addiction Medicine. This column represents his personal opinion and does not imply any position or policy taken by either the AMA or ASAM.

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Davidb   |12.200.43.xxx |2010-08-12 05:50:02 I find it quite ironic that a our society once stressd the importance of individuality; however, all our institutions are becoming increasingly uniformity. Reply 0   0

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