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Goodbye, Dr. Chips

In the classic book and subsequent film, Goodbye, Mr. Chips, we are drawn into the life of a young Latin teacher who arrives at a private boarding school for boys and stays for 60 years to become a cherished institution. It is a heartwarming, profoundly moving story of a man devoted to teaching who cares deeply about his students. In the end, when Mr. Chips finally dies, we say goodbye to him with our faith in humanity renewed.

Come now to say goodbye to Dr. Chips, the graying physician who entered the medical profession during a storied time when doctors made house calls, provided care for generations of the same family, and were honored in the community for their devotion to the ideals and practices of the healing profession.

The question is, can we also say goodbye to Dr. Chips with our faith in humanity renewed?

Part of us would certainly hope so. We don't have to sentimentalize a past that never was to appreciate the sentiment of thousands of physicians who entered the medical profession out of a genuine desire to help others and survived the inexorable industrialization of that profession with their ideals and sentiment battered but intact. We still see these selfless servants taking emergency calls at 2 a.m. for no pay or giving comfort to a sick child after the clinic has closed for the day, and in the onrushing force of the medical machine it restores our faith that there are still those who know what the right thing is and possess the moral clarity and courage to do it.

Sadly, another part of us knows better.

Physicians once embodied and defined the essence of the "caring profession." Now everything singular has become plural: physicians are only one cog in the caring professions, where the issues of reimbursement, efficiency and accountability - the domain of the machine - thoroughly dominate and eclipse notions of duty, honor and even the spiritual.

The medical industry has become a "rational" economic enterprise. Physicians are no different than plumbers - they're just better paid. We pass "Good Samaritan" laws so they can provide care without fear of being sued. Some physicians talk of forming unions, others are going back to school to get their MBAs and become executives or, better yet, proprietors of "focused factories." Professional autonomy is but a pipedream; docs toil in the back of small offices while a small army of clerks upfront handle all the paperwork and regulatory mandates. Increasingly, physicians complain of having to do more and more and enjoying it less and less.

It's not a complete rout. For example, physicians remain deeply divided on the issue of whether they should "take call" only if they get paid for it. But it's crystal clear that the bloom is off the professional rose, and there is no turning back. As medicine is increasingly reified into a set of replicable, validated and routinized set of techniques, the art will be bled out of it, and others in the caring professions will move up the economic food chain to eat the physician's lunch. The process is already well underway.

To be sure, the eclipse of Dr. Chips isn't confined to professions like teaching and medicine alone but is occurring throughout the entire advanced industrialized world. When we have perfect verification and foolproof systems, what need will there be for trust and honor? We will all be safe and secure in the machine, and live with the serenity that even though we ourselves are flawed, our tools are not.

One recoils from this vision. One wants to still feel the deep humanity of Dr. Chips, to be connected with the sentiment of abiding hope amid suffering and loss, the possibility of the transcendence of the human heart. One wants to see Dr. Chips in themselves, and to live a life that's more than series of rational, economic transactions.

So goodbye, Dr. Chips. Your light still shines here, and may it not be dimly.

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*The Drift reflects the views of the author, and does not represent the official view of SLHI's Board of Trustee and staff.