On a recent domestic flight with Delta Airlines departing the busy Chicago O'Hare International Airport, I had an unexpected, but enjoyable experience. Awaiting takeoff near the back of the Boeing 737's coach seating, I heard an announcement from the front of the aircraft. I looked up to see a man with salt and peppered hair wearing a pristine pilot's uniform and cap. After the announcement, he slowly walked to the aft of the small jet, interacting with each passenger along the way. He appeared confident, but amicable. He stopped halfway to the rear and inquired if his previous announcement had been heard. A few shook their heads. He repeated the message, which comprised of general expectations for the approaching flight. He discussed such mundane things as our destination's weather, expected duration of the flight, and our position in line for takeoff. Although the content was not necessarily gripping, he delivered this message succinctly with a contagiously agreeable disposition all the while interjecting small innocent aviation jokes like a true expert. 'The expected flight time is 3 hours and 54 minutes.", the Captain stated matter-of-factly with a grin, then after the appropriate pause, "That's pilot speak for about 4 hours." This pilot obviously loved his chosen profession. After his second monologue, our aircraft's Captain sauntered to the last row in the aircraft, greeting or exchanging pleasantries with every last passenger. Although this show had likely been performed by the Captain countless times prior to flight, it seemed like this was something pilots just don't do anymore.
This experience seemed unusually anachronistic - reflective of a time once passed. I began to think of what the flying experience may have been like during the so-called 'Golden Age of Commercial Aviation'. As a flight surgeon with one foot in aviation and another in medicine, my thoughts seamlessly transitioned to practicing in the 'Golden Age of Medicine'. Were there lessons from this experience that could be applied to both aviation and medicine? Could either profession’s ‘Golden Age’ be rediscovered?
Aviation historians will likely never agree on exact dates, but it seems many concede there was something special about the period in aviation beginning around 1930 and ending after the 1960's. This is the 'Golden Age' of Commercial Aviation, often reflected upon with nostalgic sighs of better days. In the 1920's and 1930's, the general public was swept up in the excitement of aviation's increasingly impressive feats of firsts. As the barnstorming era was eclipsed by commercial aviation, dreams of traveling to distant, exotic places became possible for many Americans. Passengers dressed in their finest clothes when a trip to the airport was imminent. The face of this exciting new transportation industry belonged to beautiful, young stewardesses and clean-cut, professional pilots. Jobs in commercial aviation were eagerly sought and when aircrew strolled through crowded terminals, all eyes turned. Marrying a pilot or becoming a flight attendant were competing dreams for many young American girls. All travelers experienced a 'first class flight', sitting in large luxurious seats and dining on multi-course meals at tables with real china attended to by young graceful stewardesses with long white gloves.Traveling by air has seemingly lost its prestige. Long lines and the pain of airport security compete with unfriendly service by overworked airlines employees for travelers' biggest complaint. These inconveniences are only magnified by new fees for previously free services and the general lack of amenities in the cattle car section of most commercial airliners. Pilots are unheard from and rarely seen as they disappear behind locked cockpit doors. Flight attendants seem to have lost the pride in their profession and often seem too busy or merely uninterested in providing high quality service.The sources of blame pointed to for these radical changes in reputation and flying experience are many. Deregulation by the 1978 Airline Deregulation Act. Over-regulation imposed by the Federal Aviation Association (FAA). Fierce competition in the the airline industry forcing companies to cut costs and amenities. Threats by hijackers and terrorists. A general regression of character by each subsequent generation?But is this really aviation's story?
PAN AM IN THE 2002 'CATCH ME IF YOU CAN'
Many medical historians have labeled the 'Golden Age' of Medicine from the 1940's to the late 1960's or early 1970's.1 Some postulate the passing of the Social Security Act of 1965, which ultimately led to Medicare and Medicaid as the defining point in which this 'Golden Age' concluded. Regardless, these penultimate epochs in aviation and medicine clearly overlap.Those who support the notion of a true 'Golden Age of Medicine' often point to a variety of arguments to support their position. Many medical innovations directly translated into increased American longevity and victory over many infectious diseases. The high opinion and strong reputation that doctors and healthcare providers enjoyed, documented by opinion polls and other cultural morays such as movies, novels, and paintings. The close, personal relationship many patients had with their physician. And the autonomy, control, and rising salaries that physicians experienced during their careers in medicine throughout this period.Many older physicians still harken back to the 'Good Ole Days'. And there are no shortage of external forces to blame for the many unwanted changes. Proponents of this narrative exclaim that the idyllic image of the good doctor and the once sacred patient-physician relationship has been replaced by a fragmented healthcare non-system, HMO's, PPO's, EPO's, excessive government regulation, high paid hospital administrators, and profit seeking pharmaceutical companies. And don't forget everyone's favorite nemesis - the insurance company.But is any of this actually accurate?
AS DOCTOR IN 2002 'CATCH ME IF YOU CAN'
All of this talk of the 'Good Ole Days' is suspiciously characteristic of a beleaguered old man sitting on his front porch, shaking a cane at passing youngsters for their generational failures. Reflecting fondly upon one's own past while blaming both the youth and other external forces is a tempting and often repeated pastime. Similar proclamations against the present youth date back to the very origins of the written word.The reason that humans trend towards this line of thought is simple. One generation's views of the past are often mistakenly biased. Although doctors did enjoy a stronger reputation, increased autonomy, and rising salaries in the 1940's, 50's and 60's; all was not rainbows and fields of opium in medicine. Oversight to protect patient safety was non-existent and patients were expected to follow their physicians' recommendations without question. Paternalistic medicine may have been easier for physicians, but was it always better for the patient? Meanwhile, doctors and their professional organizations strongly lobbied against legislation that would disturb their status quo and essentially blocked minorities or women from enjoying the many lucrative rewards the profession was experiencing.Similarly, although pilots and flight attendants during this period in the United States were highly regarded by peers and the flying experience for passengers was uniformly positive, the airlines industry was plagued by a host of very serious problems. Flying by air was disturbingly more unsafe compared to today's standards. Flying was so expensive that even most of the middle class could not afford air travel.2 Additionally, commercial air travel was a small, new industry and did not face many of the large, complex obstacles and threats experienced by airlines today.It is pretty clear that the complete notion of a true 'Golden Age' is essentially a myth. However, for the pilots, flight attendants, physicians and nurses on the front lines, it seems obvious that our reputations have been tarnished over time. Although we often blame a long list of external forces outside of our control, maybe it is time to look inward and identify tangible ways that we can improve our image and create a sort of renaissance in our respective professions, a real 'Golden Age' perhaps. This is the lesson I recently learned from the pilot in command of that Delta Boeing 737. It was a simple act of highly unexpected human-to-human interaction representing genuine empathy from a person in power over a large number of people's safety and security. Maybe in the age of NSA snooping, political scandals, faceless corporations, unreliable media sources, and massive federal organizations; maybe what we really want is just to know that those we entrust with power over our fate really are worthy of trust.
Doctors and pilots enjoy a unique position of power over the fate of their patients and passengers. They are well compensated for their expert knowledge and skill set, but both their tangible rewards and general respect have waned over the last several decades. Due to the inherent invulnerability of passengers and patients, an exceptionally high bar is set for those who guide our aircraft across the skies and cut into our bodies in the operating room. And with good reason. Excellence is the expected standard. By prioritizing the time and effort to engage in rare unexpected human interactions, as the face of the medicine and aviation, medical doctors and pilots (as well as nurses and flight attendants) can possibly recapture their once unblemished reputations and reaffirm an unwavering trust. It has been demonstrated in a number of studies that the primary reason a patient sues their physician is a sense of being disrespected or not heard during their interaction with the physician. There is an easy fix for this.
The Delta Captain's brief venture into the aircraft cabin had an absolutely huge impact. I was not the only passenger impressed by this relatively simple gesture. Many openly discussed the pilot's actions with obvious pleasure and surprise, even after landing and while awaiting for luggage at the baggage claim. This one simple gesture literally became the day's highlight for an entire airplane's travelers. No one doubted whether this pilot had the competency to deliver them safely to their destination hundreds of miles away. Although his actions didn't demonstrate a single skill in aviation, he was gold. He warmly interacted with his clients, showed them mutual respect, and reaffirmed the fact that he would do everything in his power to care for them until the aircraft landed safely at the destination.Similarly, physicians can regain their lost reputation through efforts to engage in meaningful interactions with patients in a variety of creative ways. Like passengers, patients want to feel that those controlling their fate genuinely care and respect them. This is more meaningful than anything else as the doctor's clinical competence is typically assumed (whether or not it should be!). A physician spending their scarce free moments sitting down next to inpatients and family members to engage in simple conversation rather than hiding in the doctor's workspace will pay enormous dividends. The doctor entering the waiting room to control the crowds and reassure less urgent apprehensive patients may be received with the same surprise and delight as the B-737 Delta pilot. Perhaps when these instances cease to be exceptional and become a part of the daily normal operations in both medicine and aviation, we will regain what has been lost and find ourselves thriving in yet another, more real 'Golden Age'.Then again, maybe 'Golden Ages' have never existed, relegated to the lore of storytellers and elderly men with canes on porches.
