I am only 45 years old, which is a pittance with regard to measured time past and upcoming, but thanks to the ever-increasing speed of evolution, there have been some rather remarkable changes in my lifetime. To be clear, I’m not doing the typical old-man-in-checked-pants cliche of complaining about how everything was cheaper when I was growing up. I’m talking about the rapid evolution of things that surround us in daily life. As my 5-year-old son grows older, I am envisioning attempting to explain Pong, vinyl records and Johnny Carson to him as societal touchstones in a world that features Nintendo Wiis, digital music and an increasingly unfunny Jay Leno.

Nowhere is this more apparent than the world of medicine. I was only 20 months old when the first human heart transplant was performed. I have a cousin who was a pioneer in bariatric surgery for the morbidly obese. Yet his surgical method, which was detailed in an article in Time magazine in October of 1965, when compared to today’s techniques of gastric banding and sleeve gastrectomies, could well be viewed as the medical equivalent of bleeding with leeches today.

It isn’t simply in terms of surgery. I am here to ask the reader today to bear some consideration for the evolution of medicine not simply in terms of practice and techniques, but also as it relates to the human element of being a physician in modern times.

I came across a few stories this week that showed in stark terms that the role of the doctor, as we have come to know it, has changed dramatically.

First came this synopsis of an article about physicians using social media to deliver better health care and information to patient populations. Modern patients rely on the internet as an information source in ways that challenge the delivery of health care from the modern practitioner. This article provided a window into the innovative ways that physicians can turn something viewed as a negative into a positive for their patients, as well as their practices’ bottom lines.

Now, in the interest of bringing balance to a universe existing in a constant state of chaos, the mixed-to-bad news. A study in the November issue of Health Affairs indicates that the technical knowledge of new physicians in clinical practice is lacking. The study seems to point the finger at reduced hours in residency as a big contributor, but it also pointed to changes in technology leading to a diminished skill level with regard to performing “open” procedures.

Over the last 40 years, we have seen how a society’s slavish devotion to getting everything cheaper has destroyed job after job in the American marketplace. If you thought that the medical community is immune from such an attack of thrift, think again. It was reported this week that deep in the fetid bowels of an office in Bentonville, Arkansas, Wal-Mart is planning an expansion of their well-documented retail activities into the realm of health care as a reaction to the not-quite-invalidated Affordable Care Act. As a solution to the country’s societal ills, this news ranks only slightly above ”Soylent Green is people”.

Finally, we have the curious case of Conrad Murray, the physician who was convicted of involuntary manslaughter for administering operating-room grade anesthetics to Michael Jackson in the months leading to his death. There are two problems here, the first being why this guy had a medical license to be able to implement a pain treatment plan like this, but there is a second problem here that is not being mentioned.

In this scenario, Conrad Murray is acting as an extremely well-paid concierge physician to someone with the resources to be able to afford this kind of questionable medical care. While there are a number of physicians leaving the insurance payment model to reduce administrative burden and to provide a better standard of care to their existing patient population, the high-dollar end of the concierge model is populated by physicians who are in the practice of  medicine strictly for the money. This is not to say that every physician who chooses this particular population to service is as ethically challenged as Dr. Murray, but Murray’s conviction has the appearance of a case where the number of zeroes in the pay check were directly proportional to the patient acting as his own practitioner, with the doctor acting as a spectator. Did Michael Jackson pay for a doctor, or a pusher with the imprimatur of ”M.D.” after his name in order to keep up appearances? More importantly, how many other doctors serving the well-heeled are following the same model currently, seemingly in opposition to the Hippocratic Oath? 

We have before us an interesting window of time to exist as a gatekeeper in the scientific discipline of medicine in the United States. There is progress, opportunity and danger both to the practitioners and to the patients they treat. While technology and delivery systems will continue to evolve, it is important to remember where medicine has come from since the time of Hippocrates. There will always be a part of medicine that will require a good bedside manner, manual dexterity and something more than a retail exchange. There are many mysteries about the human body yet to be discovered, but the presentation of care, at its core, has been and should remain the same.