The medicine that was

By Dr. Mary Dudzik and Dr. David Painter

On May 5, the Family Health Center, (FHC) located at 9 Hancock St., Bar Harbor, closed its doors forever. We wanted to let our patients know that we are now working at Cadillac Family Practice at 332 Main St.

But in addition to letting our beloved patients know of our change in venue, we wanted to take a minute to reflect on what the Family Health Center has meant to us.

We came to MDI Hospital from the family practice residency at EMMC in Bangor in the early 1990s. One of the main reasons we came to Bar Harbor was for the opportunity to work with Drs. Gilmore, Haynes, Caine, Cooper and Hendricks. We knew we could learn from these excellent clinicians, as their medical skills and compassionate care were highly regarded. We joined Medical Associates. Even though they were recruiting for one physician, they graciously accepted us both. We enjoyed (and continue to enjoy) our working and personal relationships with the doctors there in the building now known as the Cooper Gilmore Health Center.

Over the next several years, medicine and our own lives changed, as both continue to do so now. With the start of our young family, we wished to start a clinic that was family centered and staffed by family physicians. At that time, there was a more collegial relationship between physicians, administration and the hospital board of trustees. Although medical insurance agencies were starting to ramp up their steady march towards making a huge profit out of people’s illnesses and suffering, it was really just starting.

Physician opinions about what was needed to give high quality, patient-driven health care were heard and often acted upon. We were consulted regarding issues of office space, staffing, timing of appointment visits and record keeping. For many doctors educated in the mid 1980s as we were, the opportunity to be involved in decision making like this was a core reason we went into rural medicine. We wanted to be involved in the life of our medical practice, just as we were involved in the life of our patients.

If we had wanted to be cogs in the corporate world of a big business, we would have chosen a different profession. But as any good medical practitioner knows, medicine is a vocation, a calling. It is not only job, it is part of who we are.

We wish we could tell you the exact day the FHC opened, but we are not sure. Given the fact that we have a picture of us holding our then-8-month-old, now 21-year-old daughter at Halloween, it must have been late 1995 or early 1996. With a vision of family care that was supported by administration and the board at that time, a building was purchased, renovations were made and contracts were signed. We were the first two doctors to become hospital employees. The FHC became our medical home for the next 20-plus years.

In that time, we have been honored and privileged to care for the people of this community. We welcomed newborns in their first moments of life and comforted patients and their loved ones in their last. And we were there for all the moments in between. We have taken care of multiple generations. Over time, we have had changes in clinicians, changes in support staff, changes in office space and changes in administration. But one thing has never changed, and that is our desire to take care of patients as the individuals they are.

There is no “one size fits all” for patients. Each person has his/her/their own story. Each story is unique and requires time, patience and collaboration to find the path that will work best towards mutually agreed upon goals. This is why medicine at its core is truly an art. It is sometimes tragedy, sometimes comedy, sometimes a dance, but always an opportunity to think creatively and originally about each person in each situation.

Since the FHC opened, much has changed in medicine. Some things are wonderful and miraculous: treatment for HIV/AIDS, transplant surgery, ongoing research to tackle the problems that threaten us most. But for primary care physicians, there are many changes that are not at all good, not for our patients and not for us.

Health care decisions are made less and less by clinicians who know our patients and our craft. Decisions are made at many levels by people who have no training in real health care, whose only goal is to make or save money. Our nonprofit hospitals and medical practices are controlled by for-profit insurance companies – a recipe for sure disaster.

Insurance companies currently tell doctors what tests can be ordered, what medicines can be prescribed, how long a patient can be in a hospital, and whether or not needed medical supplies can be used. These decisions are based on what will help the insurance companies’ bottom line, not what will help patients.

Perhaps the biggest intrusion is the notion of “accountable care.” We have been, are and always will be accountable for the care we provide. Nothing is more important. There are reviews of all clinicians’ care that are embedded in hospital committees, our licensing boards and our specialty academies. But insurance companies’ idea of accountable care is quite different. Specific data must be entered into a specific template in a computer for each patient visit, and if it isn’t, we will be reimbursed less for the care that has been given.

A lot of what doctors spend their time doing now is data entry, which often duplicates what already has been documented in the patient’s record. In spite of the long, arduous education it requires to be a doctor, it is now estimated that for every hour spent on direct face-to-face patient care, a doctor will spend two hours on “busy work.”

We are doing data entry, waiting on hold to talk to an insurance company representative (generally someone with no medical education with a checklist) to come on the line so we can explain why a patient really needs that MRI or writing a letter for a third time explaining why a patient needs a certain brand of insulin.

This forces many of us to work long, unpaid hours after work and on weekends to get everything done. Yes, we are tired and burned out. But if we don’t do it, the hospital and we will not get paid. And patients will not get the care they need.

The closing of the FHC is symbolic of the corporatization of medicine. Over the last two decades, many practices have changed, Medical Associates has become Cooper Gilmore, High Street Health Center has become Cadillac Family Practice, the Women’s Health Center has become the Lisa Stewart Women’s Health Center. The Family Health Center is the first practice to be eliminated entirely.

We were not participants in the decision; we were simply informed of it. We were told that we had two days to move our own medical equipment and supplies from one space to another while simultaneously seeing patients, which was no small task. As the common quote goes, “It’s not personal, it’s just business.” But, it’s personal to us.

So, to our patients and staff, we thank you from the bottom of our hearts. Thank you for sharing your lives and gracing us with your stories in our beloved little building. We will always be grateful to you for sharing our vision of what family practice can and should be.

We look forward to continuing to see you (as well as any newcomers!) at Cadillac Family Practice. We promise you that although our space has changed, we have not.

We will continue to practice medicine the way we always have, treating each of you as the individual you are. We greatly look forward to working with Mark Kandutsch, MD, Angie Delvecchio, FNP, Linda Crowell, FNP, and Lou Ingrisano, PAC. Mary will continue to work at the Lisa Stewart Women’s Health Center as well. But please don’t be surprised if we seem a little sad. We are simply missing what once was.

David Painter and Mary Dudzik are residents of Bar Harbor.


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