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Over the holidays, my wife and I were en route to "getting away from it all." On Highway 62, midway between Yucca Valley and Joshua Pines, Calif., at the crossroads of a one-intersection nameless junction, we ran across a large, freshly painted billboard with bigger-than-life pictures of Dr. X -- "A Family Doctor Who Cares and Listens." He looked like a middle-aged banker with jowls, Ben Franklin glasses and an unduly serious demeanor. Beneath, posted on the front door of the single-story wood-and-concrete clinic, was a small hand-printed sign: "Accepting new patients."

Across the road in a small strip mall were a home-care and hospice service, an ambulance service, a storefront outpost for the Visiting Nurses' Association, Rite-Aid drugs and Ruth's Natural Foods and Herbs, with the carved wooden sign greeting: "FOR ALL YOUR HEALTH NEEDS." We stopped for coffee at the end store -- a cyber-cafe. Inside, two women were huddled over adjacent $5-an-hour terminals, comparing notes as they surfed the Web for treatments for hot flashes.

Ask Dr. Bob Dr. Robert Burton, who is a neurologist and novelist, answers health questions every Monday in Salon Health & Body. Please e-mail your queries to him at AskDrBob@ salon.com.

"What about asking Dr. X?" I asked.

"Dr. X's a good listener," one woman answered without looking up from the monitor, "but what does he really know?" The other added, "Yeah, we're taking our printouts over to Ruth. She's up on everything."

I looked out the window at the two competing signs. Ruth's, at eye level, was hip, cozy, comforting and evoked thoughts of chamomile tea, soft down quilts and feminine wisdom. The doctor's overhead commercial was overly solicitous, maybe even a bit condescending. Perhaps it was the bleaching effect of the sun, but Dr. X appeared tired and embarrassed.

And perhaps he should be. The days of the family doctor are numbered. Dr. X is on the way out. If you have any doubt, let's compare his services to those offered across the road from his office.

Take the most serious event of all -- a cardiac arrest. Who would you choose to give you CPR -- Dr. X, who probably hasn't performed CPR more than a few times in his entire career, or the paramedic from the ambulance service? And if you had the sudden onset of chest pain would you trust Dr. X's EKG interpretation, or would you prefer your EKG sent via telemetry (transmission of medical data directly over the phone) to a first-rate cardiologist (a service available at the ambulance dispatcher)?

Or, what if you have a fever and a sore throat and think you need an antibiotic. There are standard algorithms that a nurse practitioner can easily follow. But doesn't Dr. X know more about potential side effects? He did take year-long courses in pharmacology and infectious disease (many years ago). He dutifully takes annual courses in continuing education, but privately confesses that it's hard to keep up with the proliferation of new drugs and drug-drug interactions. His closest competitor, Rite-Aid, provides a printout of all possible complications, even a handy list of potentially serious symptoms that should trigger a call to your doctor. And the Rite-Aid's computer is continuously updated with the most recent recommendations culled from the latest clinical trials.

Quickly run through a list of the most common ailments about which we consult our family doc and the point becomes obvious. Lest we forget, the treatment of GI upsets and arthritis was once the mainstay of outpatient practice. Now you can get over-the-counter stomach acid blockers (Tagamet and Pepcid) and a bevy of non-steroidal anti-inflammatory meds (Motrin, Aleve, Nuprin). Dr. X can prescribe higher doses of ibuprofen than those available at the arthritis counter, but you do not have to be a rocket scientist to double the recommended dosage of Motrin. And if we want reassurance, we can watch Nolan Ryan or Jimmy Connors testimonials.

Next page | Family medicine is becoming as archaic as the manual typewriter