UHS Branches Out

Harvard University Health Services is growing -- and expanding out into the community. Officials at UHS hail this expansion as a great and progressive step. And in fact, for the community the new Harvard University Group Health Plan (HUGHP) is definitely a radical new way of getting almost total health care in a package plan.

But critics of clinic medicine say that the clinic system, besides being impersonal, will radically change the role of the doctor.

The old-style vision of pre-clinic (and pre-answering service) medicine features a graying, slightly stooped general practitioner shrugging on a topcoat and muffler in the dim morning light. His patient needs him and he is ready to help.

The new and more sterile version presents the doctor, a slick young man -- or god forbid, a woman -- punching in at 9:03 and distributing pills all day through a grilled window -- like the post office man and his eight-cent stamps. At 4:58 the doctor punches out and drives out into the suburbs where not even the answering service can find him.

UHS is crowded. The community health care plan has plunged hundreds of new patients into the system, and the bugs have not yet been ironed out. Overcrowdedness leads to rushing through appointments, which leads to a feeling of greater impersonality. But at least two doctors at UHS feel that this is temporary and not inherent in the system. And they say they feel the basic role of the doctor has not changed.

Neither Dr. Pengwynne Blevins nor Dr. Eugene Eppinger has had any extensive private practice. Blevins -- at 32 the youngest doctor on the staff -- is beginning her career after an internship, clinic work in Dorchester and Cambridgeport, and some time doing research on artherioschlerosis. Eppinger taught at Harvard Medical School for 40 years. When he retired in 1969, he began to work full time at UHS.

Both say that clinic practice -- if done correctly-- is the best way for doctors and their patients.

"This is a very pleasant time," Eppinger said. "I have no administrative duties, no problem with secretaries or with collecting bills."

Eppinger said that there was no impersonality inherent in the clinic system. "Hell no. It depends on the doctor. It can be a mechanized thing--you can be a number and just go through. It may be that way for some doctors. But I enjoy young people. I just sit here and listen to them."

He calls himself a "square" medically. What he means by that, he says, is that despite enjoying the oil-smooth administrative functions of a clinic, he sees the role of the physician from two definitely classical models.

"The doctor is not just a physician -- he's a priest. He hears people's problems and he has to have sympathy and empathy," he said.

Administratively, he copes with that viewpoint by limiting the number of patients he sees -- one per half hour for the most part to give them time to talk. Although he admits that if every doctor did that, the Health Services would grind to a halt, he says it suits his style.

"One thing I do is listen. I don't say much -- and that's a very important principle. Young people -- you just stick them and they'll talk. About themselves, their problems, and Harvard. Mostly about themselves," he said.

The other model Eppinger follows is the old school one -- of physician as community servant. He says he thinks a doctor's first responsibility is to his community. He refuses to talk politics (except at home); he says he is "divorced from the main stream academically and politically ... and happy."

"When you're in medicine, your time and energy should be in medicine. When you have other interests, they should be secondary."

Blevins, too, disagrees about the impersonality of the clinic structure. "I think physicians are beginning to realize that they can't serve patients and live their own lives as well in private practice. Here you have clearly defined responsibilities and time for yourself," she said.

She said that the "time for yourself" was important enough to offset the financial disadvantages that clinic work has. No clinic can hope to match the $50,000-$75,000 salaries that this decade's medical school students are apparently sniffing out. "I'm making less," Blevins said, "but I might have had to work all hours of the day."

Efficiency in diagnosis was another reason Blevins gave for choosing clinic work. "The resources available to me are amazing. And if I have a problem all I do is pick up the phone and find someone who knows more about the situation," she said.

Other philosophical questions are highlighted by the clinic situation. The patient's right to know what is happening to him becomes more important where future history-taking by different doctors may depend on what the patient knows about what has been done in the past. Both Blevins and Eppinger agreed strongly that the patient has every right to know about his disease and his treatment.

"I'm here for the patient, not the other way around," Blevins said. Eppinger went even further. "I give them the information without being asked for it. Then I ask them to repeat it back. When they're in here, they are frightened and anxious and in their minds there is always a possibility of their having a life-threatening disease," he said. And Eppinger, with his medical school background, firmly believes that knowledge can combat that anxiety.

Both equally strongly, however, denied the patient's right to access to his or her own medical records, saying that it would close an avenue of communication among doctors themselves.

Blevins -- one of two new doctors hired this year by UHS -- said that the fact that she was a woman played a big part in her hiring. "I'm one of their tokens," she said.

She said however that she saw nothing really wrong with that. "I think it is a field in which women have a terrific amount to offer," Blevins said. "Our whole system has been structured so that people can express their feelings to women, and women are allowed to express their feelings. Traditionally women have had the role of caring... I don't think in the past men have been allowed to do that."