Alan Berkenwald

Graduating medical school, "we" all stood and repeated, deep within our private solemnity, a modern version of the Hippocratic oath. Nowhere is a "we" to be seen. Instead, "I swear... I will keep... I will impart... I will follow..." transitions us from students to practitioners.

The most difficult question I am asked, by patients, is "Why?" Why did I become an addict? Why do I still have cravings? Why do I slip up and use, even thought I know it's wrong and I feel stupid and horrible doing it?

Now, I have never taken malpractice personally. Like most of my colleagues, I have been sued. Three cases over the last 29 years. (I am currently ahead, 2-1.) The average physician get sued once every 7 years. I was overdue.

Modern medicine's technological advances now allow more people to live long enough to develop chronic diseases where the mortality is low but the morbidity high. Hyperchondriacs are acutely aware of this, and perceive great threats in their aging and the future. Hyperchondriacs have similar attributes to hypochondrial patients even as they lack the attendant "symptoms" of a physiologic illness.

I confronted the banal face of our inefficient healthcare system, and it stares back at me in my mirror.

The "idea-immune healing artist" of medicine at the opening of the 20th-century - the general practitioner - is the ancestor to today's primary care providers who, at this new century�s beginning, still maintain their legacy (albeit barely).

Hospital administration is a complicated, taxing job. So many decisions, so many changes, and so much data collection. Practicing physicians, like myself, are confronted with new systems, new process, and the new world of computer based health delivery systems.

When I was a kid growing up, I heard that scientists had conclusively proven that Bumblebees can't fly. I thought that was hilarious. I felt like I had stumbled onto some cosmic truth, or that a secretive, hidden society's presence had just been revealed to me.

I see dead doctors every day when I work as a Hospitalist at my local community hospital...

We all know the current story with Primary Care. Myself? I got out over a year ago. I am now a Hospitalist. Shorter hours, better pay, way less paper work. No call. No hassle.

Welcome to the brave new world created by health insurance companies in Massachusetts—where all the doctors are to be above average—or their patients will be financially punished.

Working in a hospital, I spend far more time practicing social work and case management than I do medicine.