When I was a little girl my family had a neighborhood doctor just down the street from our home whose office was in a tiny old-style office building where each suite opened directly to the sidewalk. Dr. Piero Albi was a veteran of World War One, having served as a field surgeon for Italian forces. His office was humble: a small, sparsely furnished and certainly not decorated waiting room fronted two small offices and the exam room, all equally plain but functionally well-equipped. It all smelled reassuringly of antiseptic and breath mints.
In the office you'd run into neighbors and nuns from a local convent, but never a crowd of more than six because that's all there was room for. The nurse stocked some Children's Highlights magazines and last-months copies of Time from the good doctor's house on a small shelf nestled in a corner. Of humble means as we were, it was a treat to get to look at them. No-one cared that the floor was covered in black and green marble-look checked linoleum - it was spotlessly clean. No-one cared that the walls were that funny seafoam green. We were there to be helped to wellness by the kind, thin old doctor with a mild Italian accent who took his time to see one patient at a time and spend what time was needed with them.
Today, I go see a doctor at a large health management organization six miles away. It sits in a park-like setting with a sea of parking and armed security guards. The floors are carpeted in a fairly humble material, contract-care plants and original art are everywhere. It's not excessively decorated, but decorated. The exam and work areas are equipped with far more equipment than Dr. Albi would ever have imagined. Exam rooms are lined up like berths at an old style brothel, so that doctors, nurses and aides may hustle between multiple patients, although I've noted a return to taking a little more time lately. The magazines still appear to be second-hand as addresses are cut off, but are far more plentiful. We wait in droves.
In my work, I visit medical offices at times as a matter of doing my job. Some of them are decked out in fine, exotic woods, lush carpet, contract-care exotic plants, contract-care sea life aquariums and original artwork. The air is slightly perfumed by an ambiance system that also pipes in classical music. You feel like you're walking into a four-star hotel rather than a medical office. The patients waiting by the tens are not well-heeled big-spenders but everyday folk in WalMart wardrobes. They seem to enjoy the plethora of magazines and satellite TV in the waiting area. I know from my work they're expensed to the office.
Then, as a matter of my work, I'm sitting in a back corner somewhere perusing records. What I see is pharmaceutical companies bringing in to the staff big feeds of food most the patients themselves would never splurge on. Many times, too, the office itself buys the food and books it to expense. What else I see, in the books, are posh "training" conferences in destination resorts also out of the patients' reach. Having had a physician brother-in-law for some years, I know that attendance at the symposiums is often shirked in favor of fun. Of course there are those who sit through it all. Of course there is something to be said for collegial exchange.
I go to leave and look again at the patients, listening in a little to their conversations about Medicare or health insurance. I blink. My, oh my. What a long way we've come. Dr. Albi may have occasionally personally purchased lunch for his nurse and might have attended a conference now and then, although I rather doubt it. He drove a shiny black Chrysler and lived in a very nice part of town, but not in a mansion. He was better off than his patients, of course, having a job needed by all. Five or ten dollars it cost to visit him. Today an office visit is at least 75 dollars, often more; inflation explains only part of it, malpractice insurance explains a bit more...the rest, I don't know. It's paid by "the guvmint" as Medicare or by other health insurance. The doctors drive off in expensive imports to mountain homes of multiple thousands of square feet or mansions in gated communites.
It's more complex than that I know and there are examples of less lavishness. This is a simple view of an indicative norm not a rule. One must marvel.
My oh my.
