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report published by the Association of American Medical Colleges projected a shortage of as many as 150,000 physicians by 2025. Aging baby boomers are starting to become patients just as aging baby boomer physicians are getting ready to retire. The nation is going to need new doctors, especially geriatricians and other primary care physicians, to care for these patients. But interest in primary care is at an all-time low.
    Perhaps the most serious downside, however, is that unhappy doctors make for unhappy patients. Patients today are increasingly disenchanted with a medical system that is often indifferent to their needs. There has always been a divide between patients and doctors, given the disparity in power inherent in their relationship, but this chasm is widening because of time constraints, malpractice fears, decreasing income, and other stresses that have sapped the motivation of doctors to connect with their patients.
    People used to talk about “my doctor.” Of course, you had other doctors as the need arose, but you had one doctor you could call your own, and when you were sick, that doctor would be at your bedside. The archetype of a loyal, empathic family physician persisted in our culture for decades.
    Today care is widely dispersed. In a given year, Medicare patients see on average two different primary care physicians and five specialists working in four separate practices. For many of us, it is rare to find a primary physician who can remember us from visit to visit, let alone come to know us in depth or with any meaning or relevancy. Many primary care physicians are no longer able to care for their patients who have been admitted to the hospital, relying instead on hospitalists devoted to inpatient care. It has become prohibitively inefficient for primary care physicians to leave the office for several hours—to drive to a hospital, examine a patient, check laboratory tests and vital signs, talk to a nurse, and write orders and a note—for just one or two patients. The economic calculus is such that if they did this on a regular basis, they wouldn’t have enough revenue to pay their staff, their rent, and their malpractice insurance. The upshot is that the doctor who knows a patient best is often uninvolved in her care when she is hospitalized. This contributes to the poor coordination and wanton consultation that are so common in hospitals today. “Years ago you had one or two doctors,” a hospitalized patient told me. “Now you’ve got so many people coming in it’s hard to know who’s who.”
    Not long ago I took care of a woman with an abdominal mass who had been transferred to my hospital for a preoperative evaluation. No one knew exactly what the mass represented or even whether she had had a biopsy—including the physician at my hospital who had accepted the transfer. The paperwork from the other hospital was a mess, incomplete; no one could make any sense of it. And the doctor we reached at the transferring hospital knew next to nothing about the patient. I told my patient that there were some things we needed to figure out before sending her to the operating room. “Like what?” she asked.
    â€œLike what is this mass,” I answered. “Is it cancer? Has it spread?”
    â€œDo you know if it has?”
    â€œI don’t, ma’am. I’m just meeting you for the first time.”
    Tears filled her eyes. “No one knows what is going on,” she said, and she was right. I was eventually able to tell her it was a benign mass, but not before she had been tortured by worry for two days. It is hard to imagine such a thing happening in the era of “my doctor.”
    Insensitivity in patient-doctor interactions has become almost normal. I once took care of a patient who developed kidney failure after receiving contrast dye for a CT scan. On rounds he recalled for me a conversation he’d had with his nephrologist about