A Simple Day in a Bookstore
Independent Physicians and Bookstores: One of my most cherished memories is from when my daughter was just four years old. We spent an afternoon at a local independent bookstore, flipping through picture books adorned with puppies and kittens. I read to her, we joined a story circle, and neither of us remembers the titles—but we remember the feeling. Years later, she now takes her own daughter to the last indie bookstore in Columbus, Ohio, often timing visits with our trips so we can experience the wonder together as a family.
Wandering those aisles reminded me of something I haven’t been able to shake: independent bookstores and private practice doctors once offered the same thing—a place where human connection came first. And in today’s health care system, that kind of connection is becoming increasingly rare.
The Quiet Disappearance of Independent Practice
Just a few decades ago, most physicians in the United States operated in private practice. They knew their patients by name, followed entire families over generations, and exercised autonomy over how they delivered care. Today, over 80% of physicians are employed by large health systems. The reasons are not surprising:
- Financial pressure: Reimbursement has plummeted while operational costs have skyrocketed.
- Administrative burden: Prior authorizations and EHRs eat into time that should be spent with patients.
- Consolidation: Corporate acquisition of practices promises security but often erodes professional independence.
While some of these changes offer efficiencies, the result is clear: many physicians no longer have the time or space to build deep, sustained relationships with patients.
What Gets Lost
Much like indie bookstores, private practices cultivated a sense of personalized service and community care. Readers trusted their booksellers for guidance; patients trusted their doctors for healing. Both relationships were built over time, through conversation, presence, and mutual respect. Independent Physicians and Bookstores
Now, algorithmic recommendations replace human guidance, and telehealth protocols substitute for face-to-face care. These changes may bring convenience, but they come at a cost: the erosion of trust, nuance, and continuity.
As a professor once wrote in a chapter I solicited—ironically titled “Does consolidation in health care mean bigger is better?”—mergers rarely fulfill their promises unless they explicitly account for organizational culture and human behavior. When we ignore the human side of these systems, we create sterile environments where both patients and physicians feel lost.
A Path Back to Purpose
But it’s not all loss. Around the country, some physicians are pushing back—reclaiming autonomy through concierge models, direct primary care, or micro-practices. Patients, too, are rediscovering the value of continuity in care. At the same time, independent bookstores are reimagining their roles: hosting events, serving coffee, and becoming community centers once again.
These are not just nostalgic gestures. They reflect a growing desire to return to meaningful, human-centered relationships—where listening matters more than metrics and presence matters more than profit.
Why It Matters for Physicians—and Patients
For those of us in medicine, the lesson is clear. We cannot outsource empathy, digitize trust, or scale presence without losing something vital. Whether we’re treating a patient or recommending a book, what people most need is someone who truly sees them.
At Stanford Physician Advocate, we believe restoring this connection isn’t just a nice idea—it’s essential to rebuilding a health care system that prioritizes both provider well-being and patient care.
By Arthur Lazarus, MD, MBA
Excerpt adapted from Narrative Medicine: New and Selected Essays
Read More from StanfordPhysicianAdvocate.org
- How Vaccine Hesitancy is Reviving Deadly Childhood Diseases
- How a Coaching Culture Reduces Physician Burnout
- Hidden Crisis in Health Care: How Corporate Greed is Undermining Patient Care
- Transforming Health Care Leadership: Prioritizing Care for Providers and Patients
- The Financial Pressures Reshaping Physician Priorities
Join the Movement
We invite you to share your own story of human connection in medicine. How have you kept relationships alive in a changing system? What would help you reconnect?
Let’s reclaim the heart of medicine—together.