When Dr. Charles Yockey graduated from Kansas University Medical School in 1972, hospital stays averaged more than two weeks, many physicals lasted three days, and his current position would not be created for 25 years.
Now, Yockey, medical director of the hospitalist program at Lawrence Memorial Hospital, said hospital stays at LMH average about two days and physicals last closer to an hour because of technology and diagnostic advances in the health care industry.
While CT scans and MRIs were uncommon in the 1970s and ’80s, Yockey said nearly every patient with questionable symptoms in the hospital receives CT scans even as a protective measure.
“In 1986 when I left Wichita, there was a huge argument about how many MRI machines you can have in one town,” he said. “There was a huge debate if they could have two — now they have 10 and probably are getting another two this year.”
Also, hospital stays have shrunk dramatically because of advancements in diagnosis and surgical procedures, which often take place at outpatient clinics, where nurse practitioners and physician’s assistants can perform similar procedures to a doctor.
“All the things we used to do in a hospital 30 years ago, most of them are now done as an outpatient,” he said. “When I had my gallbladder procedure in 1977, I had a long incision and I was in the hospital a week. Now, you can do that as an outpatient and have three small incisions and be back to work in three days.”
Meanwhile, advances in antibiotics and other pharmaceutical drugs have reduced the required stay at a hospital.
When he started as a physician, Yockey said he had three prescription choices for high blood pressure — all of which caused uncomfortable side effects.
Outpatient services increase
Yockey said when he was in medical school in the 1960s and early ’70s, doctors would run 24-hour urine collections and a plethora of other meaningful tests because they had little else to help them determine a difficult diagnosis.
The rise of outpatient clinics, as well as hospitalists, who specialize in hospital medicine and attend to medical needs of patients during their stays, have freed up other physicians to specialize and have more family time.
“Twelve years ago there would be 35 doctors taking care of the 70 patients we have today,” he said. “Now there is four. It allows the doctors that used to come to the hospitals to see one or two patients to stay at the office all day.”
Still, physicians are spending only 14 percent of their jobs with patients compared to 95 percent 30 years ago. The rest of the time — 86 percent — is mostly spent filling out paperwork or electronic records.
“The challenge is to take care of the patient that 14 percent of time and make sure they are getting the care they deserve and need,” Yockey said.
With every advancement in the health care industry, Yockey said the costs have also risen dramatically. For example, a pill to fend off staph infections costs $150 a pill and $2,100 over a two-week regimen. CT scanners and other medical machinery often cost millions of dollars, and malpractice coverage has risen from a few hundred dollars to several thousand a year.
The art of medicine
Yockey said when insurance companies started paying for more routine medical procedures and visits a couple of decades ago, people took less care of themselves, causing insurance costs to go up along with the increase in expensive equipment.
“All this costs money,” he said. “In 1350, the most common diagnosis was overheated blood and the treatment was blood letting. We’ve come a long way since then, but the reality is that 90 percent of the money that you will spend on health care is spent in the last year of life when it probably can do the least amount of good.”
While the industry has experienced dramatic changes over the past 50 to 60 years, Yockey said the art of medicine has not changed. Patients still need people to care for them and to provide hope and confidence.
Yockey said people today seek the same three qualities in their physician that they did 40 years ago: a knowledgeable and competent doctor, a doctor who cares and a doctor always there when they need help.