Em’s dead. Read this and you won’t feel so hot either.

I hesitate to give you his full name; let’s just call him Em. We met 45 years ago in school and, curiously, stuck together through thick and thin, friends for a long time. I learned a lot from Em, and he brought out possibly the very best in me. He revealed things which occasionally made me sick. It wasn’t his fault, he’d say. “Joe, that’s just the way life is.”

Together we weathered the hassles through which you must persevere to do this job. Supporting each other through crises, learning neuroanatomy, physiology, biochemistry, histories and physicals. I even thought of him fondly when I was standing over a cadaver, learning the art as Galen did eons ago. I knew that he, as well as I, had felt tears well up when we gave our fine patient/friends bad news in our clinical years.

Em was just incredulous when I told him about my big decision to pursue dermatology. He was with me the day I told Ward, the chief of surgery, that I was interested in dermatology and he joked, “Well, Joe, that’s just being an externist, isn’t it?” What he didn’t know was that dermatology is the window on one’s internal health, and could effectively make one a detective as surely as Arthur Conan Doyle did Sherlock Holmes.

Em listened as I anxiously told him about the first simple note I had written in derm clinic: “Bobby is a 10-year-old with a wart on his right index finger. Frozen. Return three weeks.” It was plenty sufficient, but slowly became less and less so, as there were more and more papers to sign and more complicated notes and physicals to dictate. And all along, Em grew sicker and sicker. He’d say, “Joe, that’s just the way life is.”

So as insurance stuck its ugly head into our practices, and bean-counters and middlemen and frivolous legal matters started taking more and more of our resources, Em went along with it like we all did; he bit the bullet, increased his prices while his costs skyrocketed and gritted his teeth thinking he could see himself through what he now saw as the life of our clinical practice being sucked dry by outside forces, while the time-honored eye-to-eye, hand-holding, comforting, trusting, listening of our practices slouched under the bureaucratic weight of new demands heaped upon us.

I bitterly argued with Em that we were being crushed by it all, and now “they” wanted us to put all the information about everybody and about every body into a computer so that somebody somewhere, could count all the beans and charge our patient/friends amounts we knew they could not bear. I thought of my mentor Glenn, accepting two jars of clover honey as payment for a surgical procedure.

Eventually, we were forced under penalty, to use laptops and iPads and generate useless information about so many of our friends/patients, including photocopies of driver’s licenses, job information, insurance forms, pre-authorizations, e-prescribing, photos of everything to insure that we had really seen the patient for the listed problem. And for the first time ever, I began to dislike Em, who seemed to go along with all this interference, while it slowed him by over half his productivity, resulting in increased prices. I could not understand him or his reasoning, but it seemed as if he was sick. He just smiled and said, “Joe, that’s just the way life is.”

Em grew sicker and sicker. While I watched him ebb away we tried to explain the way it was back in Glenn’s day. We tried to convince patients that we were still their friends and that we, too, remembered when Em was healthy and vigorous.

But he eventually succumbed to that final straw that broke his back. Em was dead. And when I gave my best friend his last good-bye and spoke his eulogy, we all missed those days of doing what a patient needed, rather than what a bureaucrat wanted. We knew, if Em could speak, he might regret that phrase.“Joe, that’s just the way life is.” Em died. We lost him in a blizzard of records, finances, trivialities, computerized slowdowns with decreased productivity, and the fact that our patient/friends had now just become patients. For Em, you see, was the first letter of my beloved . . . Medicine.

This story was originally published November 10, 2017 at 6:17 AM with the headline "Em’s dead. Read this and you won’t feel so hot either.."