The Way We Were

A jammed sharps container doesn't sound like the kind of thing to trigger a nostalgic reverie, but the other day one of them did just that.

Back in 1981, after my first day in my current office building, my secretary called me at home to say that the janitor was furious: He'd been stuck by a needle that came loose in one of the garbage bags.

We used to put capped needles in the trash!

Yes, there were needle breakers, little red plastic boxes that snipped off needles at the hub, but we didn't always use them; instead, we just screwed the needles into their plastic hubs before discarding them.

Then came AIDS and the Occupational Safety and Health Administration and sharps containers, but even those evolved. The first ones were crude affairs that let you poke inside to retrieve something and possibly get jabbed. Newer models eliminated that chance with one-way-valve openings. Change is troublesome but inevitable. We look for some of it, some we have thrust upon us, and the rest just sneaks in somehow.

Because most change is slow and incremental, it's hard to remember what things were like even a few years ago. We're always brought up short when we see a snapshot, an old TV sitcom, a movie like "Back to the Future." "Hey look, 'Bonanza!'" "I haven't seen a hand lawn mower since I was a kid." "How about those bell-bottoms?" "Look, Windows 98!" (That's for the younger set.)

My office past came blasting through recently in this exchange:

"Your skin cancer will need surgery, Mr. Mortimer. What hospital is your PCP with? I have to choose a specialist from the right referral circle."

"I have Blue Humdinger Supreme, Doctor. I can go anywhere."

"What?"

"I can go anywhere."

"You can go anywhere …?"

(I am running in slow motion through a green meadow filled with crimson wildflowers. Smiling models from nonsedating antihistamine ads are sitting at picnic tables, joyfully inhaling pollen. I can send my patients anywhere I want! It's a dream!)

Actually, it is. But once upon a time I could. Anybody could see me without referrals, and I didn't need an army of referral clerks. I could schedule a follow-up visit just because I wanted to. … I could write a prescription for any drug I felt like. …

We fixed typos with Wite-Out correction fluid. There was no voice mail or e-mail. Faxes had not been thought of. There wasn't any health insurance, and patients paid in chickens, if they paid at all.

You win some, you lose some.

We can't hide from change, but it may be best not to be the first kid on the block to adopt it, either. Let other people work out the bugs, and wait for the higher prices of early adoption to come down.

It's also a good idea to ignore the predators who are always ready to cash in on our fear of instability. They're the ones who send out those screaming flyers, "Give Us Lots of Money and We'll Protect You From the Latest Government Threat!" Better to wait for soberer voices, like those of our professional associations, to assess the situation and give guidance. The sky won't fall in the meantime.

Sometimes, change is so sensible it makes you wonder why it took so long to happen.

Back when I started, I sent pathology specimens to a lab at the derm department of my alma mater. They supplied me with little white cylinders containing a formalin bottle and path slip. Printed on the cylinder were the lab's address and a notice, "No postage necessary if mailed in the United States."

We sent specimens … by regular mail! (Online tracking was not available.)

"Dr. Rockoff, do I have melanoma or not?"

"Hello, lab, do you have the biopsy on Mr. Mortimer? … What do you mean, 'Who is Mr. Mortimer?'"

Yes, things like that really happened. Sometimes the missing cylinder eventually showed up, many palpitations later.

At some point in the early 1980s, some labs started offering courier service. Soon, all the rest followed suit.

See? At least in some respects, these are the good old days.

A jammed sharps container doesn't sound like the kind of thing to trigger a nostalgic reverie, but the other day one of them did just that.

Back in 1981, after my first day in my current office building, my secretary called me at home to say that the janitor was furious: He'd been stuck by a needle that came loose in one of the garbage bags.

We used to put capped needles in the trash!

Yes, there were needle breakers, little red plastic boxes that snipped off needles at the hub, but we didn't always use them; instead, we just screwed the needles into their plastic hubs before discarding them.

Then came AIDS and the Occupational Safety and Health Administration and sharps containers, but even those evolved. The first ones were crude affairs that let you poke inside to retrieve something and possibly get jabbed. Newer models eliminated that chance with one-way-valve openings. Change is troublesome but inevitable. We look for some of it, some we have thrust upon us, and the rest just sneaks in somehow.

Because most change is slow and incremental, it's hard to remember what things were like even a few years ago. We're always brought up short when we see a snapshot, an old TV sitcom, a movie like "Back to the Future." "Hey look, 'Bonanza!'" "I haven't seen a hand lawn mower since I was a kid." "How about those bell-bottoms?" "Look, Windows 98!" (That's for the younger set.)

My office past came blasting through recently in this exchange:

"Your skin cancer will need surgery, Mr. Mortimer. What hospital is your PCP with? I have to choose a specialist from the right referral circle."

"I have Blue Humdinger Supreme, Doctor. I can go anywhere."

"What?"

"I can go anywhere."

"You can go anywhere …?"

(I am running in slow motion through a green meadow filled with crimson wildflowers. Smiling models from nonsedating antihistamine ads are sitting at picnic tables, joyfully inhaling pollen. I can send my patients anywhere I want! It's a dream!)

Actually, it is. But once upon a time I could. Anybody could see me without referrals, and I didn't need an army of referral clerks. I could schedule a follow-up visit just because I wanted to. … I could write a prescription for any drug I felt like. …

We fixed typos with Wite-Out correction fluid. There was no voice mail or e-mail. Faxes had not been thought of. There wasn't any health insurance, and patients paid in chickens, if they paid at all.

You win some, you lose some.

We can't hide from change, but it may be best not to be the first kid on the block to adopt it, either. Let other people work out the bugs, and wait for the higher prices of early adoption to come down.

It's also a good idea to ignore the predators who are always ready to cash in on our fear of instability. They're the ones who send out those screaming flyers, "Give Us Lots of Money and We'll Protect You From the Latest Government Threat!" Better to wait for soberer voices, like those of our professional associations, to assess the situation and give guidance. The sky won't fall in the meantime.

Sometimes, change is so sensible it makes you wonder why it took so long to happen.

Back when I started, I sent pathology specimens to a lab at the derm department of my alma mater. They supplied me with little white cylinders containing a formalin bottle and path slip. Printed on the cylinder were the lab's address and a notice, "No postage necessary if mailed in the United States."

We sent specimens … by regular mail! (Online tracking was not available.)

"Dr. Rockoff, do I have melanoma or not?"

"Hello, lab, do you have the biopsy on Mr. Mortimer? … What do you mean, 'Who is Mr. Mortimer?'"

Yes, things like that really happened. Sometimes the missing cylinder eventually showed up, many palpitations later.

At some point in the early 1980s, some labs started offering courier service. Soon, all the rest followed suit.

See? At least in some respects, these are the good old days.

A jammed sharps container doesn't sound like the kind of thing to trigger a nostalgic reverie, but the other day one of them did just that.

Back in 1981, after my first day in my current office building, my secretary called me at home to say that the janitor was furious: He'd been stuck by a needle that came loose in one of the garbage bags.

We used to put capped needles in the trash!

Yes, there were needle breakers, little red plastic boxes that snipped off needles at the hub, but we didn't always use them; instead, we just screwed the needles into their plastic hubs before discarding them.

Then came AIDS and the Occupational Safety and Health Administration and sharps containers, but even those evolved. The first ones were crude affairs that let you poke inside to retrieve something and possibly get jabbed. Newer models eliminated that chance with one-way-valve openings. Change is troublesome but inevitable. We look for some of it, some we have thrust upon us, and the rest just sneaks in somehow.

Because most change is slow and incremental, it's hard to remember what things were like even a few years ago. We're always brought up short when we see a snapshot, an old TV sitcom, a movie like "Back to the Future." "Hey look, 'Bonanza!'" "I haven't seen a hand lawn mower since I was a kid." "How about those bell-bottoms?" "Look, Windows 98!" (That's for the younger set.)

My office past came blasting through recently in this exchange:

"Your skin cancer will need surgery, Mr. Mortimer. What hospital is your PCP with? I have to choose a specialist from the right referral circle."

"I have Blue Humdinger Supreme, Doctor. I can go anywhere."

"What?"

"I can go anywhere."

"You can go anywhere …?"

(I am running in slow motion through a green meadow filled with crimson wildflowers. Smiling models from nonsedating antihistamine ads are sitting at picnic tables, joyfully inhaling pollen. I can send my patients anywhere I want! It's a dream!)

Actually, it is. But once upon a time I could. Anybody could see me without referrals, and I didn't need an army of referral clerks. I could schedule a follow-up visit just because I wanted to. … I could write a prescription for any drug I felt like. …

We fixed typos with Wite-Out correction fluid. There was no voice mail or e-mail. Faxes had not been thought of. There wasn't any health insurance, and patients paid in chickens, if they paid at all.

You win some, you lose some.

We can't hide from change, but it may be best not to be the first kid on the block to adopt it, either. Let other people work out the bugs, and wait for the higher prices of early adoption to come down.

It's also a good idea to ignore the predators who are always ready to cash in on our fear of instability. They're the ones who send out those screaming flyers, "Give Us Lots of Money and We'll Protect You From the Latest Government Threat!" Better to wait for soberer voices, like those of our professional associations, to assess the situation and give guidance. The sky won't fall in the meantime.

Sometimes, change is so sensible it makes you wonder why it took so long to happen.

Back when I started, I sent pathology specimens to a lab at the derm department of my alma mater. They supplied me with little white cylinders containing a formalin bottle and path slip. Printed on the cylinder were the lab's address and a notice, "No postage necessary if mailed in the United States."

We sent specimens … by regular mail! (Online tracking was not available.)

"Dr. Rockoff, do I have melanoma or not?"

"Hello, lab, do you have the biopsy on Mr. Mortimer? … What do you mean, 'Who is Mr. Mortimer?'"

Yes, things like that really happened. Sometimes the missing cylinder eventually showed up, many palpitations later.

At some point in the early 1980s, some labs started offering courier service. Soon, all the rest followed suit.

See? At least in some respects, these are the good old days.