Despite a cold and dark winter's night, I found myself warm and happy as I walked back to my car after attending a performance of Giuseppe Verdi's Requiem by the Cleveland Orchestra. While a requiem is a Mass for the dead, Verdi's Requiem isn't your classic mournful ceremony. It's a fantastic emotional back and forth, full of drama and solemnity, terror and faith, grief and peace. The final act, Libera me, is breathtaking in its beauty, as it ultimately delivers a message of hope.

With my mind still buzzing from the concert, I thought perhaps we need our own requiem in family medicine — not a requiem for the specialty itself but for how things used to be. So, if you'll indulge me, here's my soon-to-be classic masterpiece, a Requiem for the Old Way (in four parts) in the spirit of Verdi.

ACT I: DIES IRAE — “THE DAY OF WRATH”

Physician burnout is an issue that must be reckoned with. Verdi used thundering bass drums to announce the Dies irae, so try to imagine that dramatic sound right now. Better yet, go watch it. We are facing a crisis of physicians being overworked and undervalued. Much of this comes from the “27-hour workday,”¹ that is, the time it would take a primary care physician to provide all the preventive, acute, and chronic care their patients need as well as answer messages, address metrics, and the like. Our lacrimosa — our day of tears and struggle — happens every day.

ACT II: RECORDARE — “REMEMBER”

Amid our struggles, we need to pause and remember what matters. The common denominator between the “old way” and “new way” is the patient. To paraphrase and oversimplify Atul Gawande,² the most powerful tool in medicine is the doctor-patient relationship. Fostering that relationship is our best path forward.

ACT III: LIBERA ME — “DELIVER ME”

Verdi's Libera me is a plea for deliverance, and that's exactly what we need — deliverance from burdensome prior authorizations, meaningless metrics, and administrative harm.³ We need to be able to walk into the exam room with the patient and have no demons awaiting us on the other side of that door. We need freedom to practice medicine the way we were trained.

ACT IV: LUX AETERNA — “ETERNAL LIGHT”

What does practice look like on the other side? I imagine it involves leveraging team-based care to free doctors from nonclinical duties, leveraging AI tools efficiently and effectively to augment our training and experience, and embracing different payment models to get us off the fee-for-service hamster wheel. The result is happy patients and happy doctors. We come home from work on time with charts done, knowing we spent our day actually helping our patients. We finally achieve true transformation, a joyous end to my requiem!

LET'S WRITE A GOOD ONE

OK, so it's not a traditional requiem. I've never written one before, so I think a little leeway is in order.

Verdi played with the framework for his Requiem for many years, but it wasn't until he was 60 years old that he finally put pen to paper.⁴ According to lore, he was content in his semi-retirement and reluctantly created this transformational masterpiece only after learning of the death of his friend and fellow composer Alessandro Manzoni. Out of tragedy, something amazing was born.

Perhaps I'm naive, or perhaps I'm still just carrying a post-Verdi buzz, but I believe family medicine's lux aeterna is coming.