I spent a good part of the afternoon
with Don and Phyllis Rames at their home on 7th Street. I was interested in talking with Don because he spent nearly all the years of his practice of medicine as a family doctor in Vandalia. From 1956 to 1984 he practiced obstetrics as well as general medicine, delivering more than 2000 babies over those years. He told me it was gratifying to deliver a baby, then years later to deliver her daughter, and years after that to deliver her granddaughter. He said his relationship with his patients was more than a doctor-patient relationship - "these people were my friends." The high point of his practice was sharing their joy at the birth of a baby, new life, promise of the future, hope for tomorrow. The hard part - "telling a friend he or she had cancer and talking with them about everything that entailed." Don got to share Vandalia's joys, he also shared its sorrows.
How did medicine change over the forty-six years of his practice? Malpractice claims drove up the cost of insurance such that he had to leave obstetrics in 1984 even though he loved the work. "Some people think every baby is guaranteed to be a perfect baby," Don said, "and that's not the case. And it's not always the doctor's fault. Lawyers are quick to file suit, whatever the merits of the case, and insurance rates go up." Government regulation, Medicare, and insurance have also affected the practice of medicine.
How else did medicine change? When Don was looking to set up practice in the mid-50s, rural areas of the middle west were generally well-supplied with physicians. Today, he said, there are fewer doctors who wish to practice in rural America. Federal incentives are now used to draw doctors to under-served areas.
There was also less night and weekend work now than there used to be, Don said. Partly, he hasn't been called to deliver babies in the middle of the night since 1984; partly, he hadn't had to answer emergency calls in recent years now that there's a 24-hour emergency room at the hospital. In addition, several doctors have banded together to cover each other's weekend calls on a rotating basis, with the result that physicians can now depend on some time off.
Technological advances have also meant better medical care for patients, yet Don would probably say that healing has as much to do with the physician's hand and care and concern - the relationship - as it does with new technology and new medicines. He doesn't say it but one senses that the comfort of the physician's hand was always of paramount importance in his practice, whatever the state of medical technology.
To be continued....
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