Why is Dr. Welby an endangered species?

From 1969 to 1976, ABC-TV aired the nighttime drama in which Robert Young played a family physician in southern California, devoted to his patients, largely using the nuances of communication and physical exam to explore and heal the sometimes messy human condition. Juxtaposed to the kinder, gentler Welby, the younger Dr. Kiley (James Brolin) represented the aloof physician in “traditional medical practice.” Welby was a student of humanity, Kiley a student of textbooks.

The character didn’t always get it right – or should I say, the show’s writers and producers didn’t always get it right (see the ridiculous treatment of homosexuality) – but the humanity and healing of the insightful, caring doctor, who took his time with patients, and who trusted his powerful subjective skills, came through.

So Dr. Welby represented two things: (1) the doctor who trusted his hard-earned clinical wisdom, rather than overly value technology, when achieving diagnosis and implementing treatment, and (2) the empathetic, laying-on-of-the-hands, ‘I have time for you’ family physician as non-denominational clergy.

What happened to those men and women?

Physicians in training don’t want to become Dr. Welby, for three main reasons: (1) traditional primary care practice doesn’t reliably cover hundreds of thousands of dollars in student loans, (2) the work-life of traditional primary care is too hectic, and (3) the many, varied contributions to healing that take place in a primary care practice are too often devalued by the medical community.

Physicians in practice have too often forsaken the time-consuming task of history-taking, performing a focused physical exam and the hard work of medical reasoning, opting instead to order every test and imaging study under the sun in the hopes doing so will reveal the diagnosis. Some say this phenomenon has to do with our medical-malpractice environment. Bull – a convenient excuse.

We behave differently in the Permanente Medical Group. We pay our primary care physicians more. We give them more time to spend with their patients. We encourage them to trust their hard-earned clinical skills and medical reasoning. We build information architecture (EMR with Decision-Support), create effective workflows (Patient Centered Medical Homes), and nurture a culture of patient-centered group-practice, where colleagues rely upon one another and continuously improve. Oh – and we have one of the lowest rates in the state of medical malpractice allegations.

So the next time someone asks you, “Where did Dr. Welby go?” you’ll know how to answer.

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