January 10, 2000

Guillermo Sanchez, MD

Amid the thousands of employees and patients who travel the corridors of the MGH every day, there are a handful who remember what life was like at the hospital in earlier days. One of them is Guillermo Sanchez, MD, of the Department of Medicine and co-chair of the MGH Archives Committee. He came to the United States from Guatemala to attend Harvard College and Harvard Medical School and began his work at the MGH in 1949.

"The hospital today is much larger, with much better patient facilities than when I came here," he says. "Back then, there were open wards. Now patients have more privacy and can feel much more comfortable when they are here."

This 50-year veteran says that extraordinary advances in medicine, new drugs and treatments and the wealth of information available to doctors and patients have combined to improve patient care immeasurably. Yet despite these strides in care, the challenges involved with paying for these services has affected the health care system. "Years ago, doctors had closer, more personal relationships with their patients, and they made decisions about care together. But costs of care were mounting so rapidly that there was no choice than to let business people call many of the shots. Today, doctors must make decisions about a patient’s care based on what managed care agencies say they can and cannot do. Patients are required to choose their doctor based on a list of ‘network’ doctors from their insurance company, and doctors refer their patients to those who are in the same network."

He also says that the demands on doctors today are greater than 50 years ago. This increased stress has affected the relationships among medical staff. "Back in the 1950s, doctors, residents and interns would go on their rounds and then all go down to the cafeteria to eat lunch together. Nowadays, house staff are much more structured. They attend many more lectures. Today they are treating sicker patients, and they must learn about the sophisticated equipment and monitoring systems that are used routinely," he says. "While the training program here is excellent, the changes in medical education have made life at the MGH more complex for residents."

As better ways to treat patients are discovered, the hospital and the care delivered in it will continue to evolve. And along with the advances in medicine, there has been more of a focus in recent years on primary care. Similarly, greater emphasis is being placed on patient-doctor relationships — more the way it was when Sanchez first became a physician.