More than 50 years ago I was helping to move massive six-inch blue stone slabs in my garden when pop—my intestines slipped through my flabby muscle wall. I had a painful hernia.

We had had all three babies at Mt. Sinai Hospital, so we asked the baby doctor for a hernia surgeon and soon I was in a cab on my way to my first operation. (They called it that then, not a “procedure.”) Not one but two young surgeons were assigned to my case and they visited me before the event and showed me my X-ray. They came to see me after the event, and I was in the hospital for a day and a half before I went home in a cab.

Flash forward 50 years. I felt my intestine pushing through my stomach wall just as before. I called my nice young doctor, who scheduled a procedure. I had the name of the surgeon, but I would only meet him at the event.

I took a cab to Phillips Ambulatory Care Center, run by Beth Israel at 15th Street and Park Avenue South, and walked into a room with a table on which I was to lie but that held none of the familiar operating room gear. They put me out and before I knew it I was awake and they helped me to a chair to get over the anesthetic. An hour later I took a cab home

If you want to know what is happening to the practice of medicine, I think this explains it.

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