Meet Dr. David Mokotoff, soon to be a casualty of the federal government’s involvement in health care.  His article in “Physician’s Practice” is here, where he very kindly mentions our facility.  He is tired, sick and tired, not of taking care of patients but rather jumping through the hoops and taking the abuse the federal government and its health cartel reserves for private practice physicians.  

It is impossible to quantify the damage done to the clinical work force the departure of experienced clinicians like Dr. Mokotoff represents.  The clinical judgement of countless physicians with 30 or more years of practice will soon be gone, as doctors like Dr. Mokotoff quit.  This brain drain of older, more experienced clinicians will translate into a higher titer of the sophomoric mistakes characteristic of every beginning clinician’s practice.  I’m not suggesting that young physicians enter medical practice  unprepared for what’s coming at them.  I’m simply stating that we all become wiser with time, benefitting from years of experience, highlighting, I think why we refer to medical “practice.”  

I’ve heard old neurosurgeons talk of their mentors whose neurological exam was so intricate, even elegant,  that discreet neurological lesions could be identified, long before the appearance of CT scanners or MRI machines.  Older orthopedists diagnosed meniscal tears and cruciate ligament tears and rotator cuff tears with uncanny accuracy prior to the technology used today to confirm these diagnoses.  Many of these doctors will soon, like Dr. Mokotoff, retire from practice.  

This is a very chilling and sad example of Bastiat’s concept of “what is not seen,” in this case, the disappearance of the not infrequent, out-of-the-box and life-saving clinical judgement calls, that many times are made by our older and more experienced colleagues.  After all, after seeing thousands of patients, we are all more adept at identifying patients who don’t “fit the mold.”  

While there is much to be said for the ebullience and boundary-questioning of the bright, young new physicians, the loss of wise and experienced clinicians in large numbers due to the latest federal intrusion into medical practice, should not be overlooked.

G. Keith Smith, M.D.