It's moving day. After 25 years in one spot, our clinic is moving. Not very far. We have all packed up and are relocating in a renovated office next door.

Every time someone moves, be it from a house or an apartment or — in this case — a medical clinic, they have to decide what they need and what to leave behind. Sometimes these possessions seemed so indispensable just minutes before the move; now they are some form of human-generated waste jettisoned overboard.

There were textbooks from medical school, journals in 2-foot tall stacks and conference notes scattered over the floor. Looking at the piles, my regret was not the need to discard old books or papers, but thinking how much medicine had changed in a quarter of a century. Facts then are not facts today. Explanations for genetics then are taught in junior high now. MRIs were theoretic then and essential now. Medicines from then have patented blockbusters replacing them, some doing exactly the same thing at 10 times the cost. Others address illnesses in novel ways only imagined before.

There are diseases now we never considered before. I remember reading in the New England Journal of Medicine about how a few men in Los Angeles were showing up in clinics with a rare cancer called Kaposi's sarcoma. The only link between the patients was they had sex with other men. HIV and AIDS were yet to be discovered and yet to be treated. Back a generation, we had maybe only three or four antibiotics to treat common children's infections. Now there are multiple generations of some drugs, though bacteria has evolved faster into multiple resistant organisms.

The numbers of infectious diseases that can be prevented with immunizations have made this part of the world relatively free of measles, mumps, rubella, H. influenza meningitis, chicken pox, hepatitis A and B, diphtheria, tetanus, polio and invasive pneumococcus. Now it seems pediatricians are seeing more kids with problems in school or in their own personal lives. Anxiety and depression — including bipolar disease — are the new plagues of pediatrics. Are we crazier, or just more likely to talk about it?

When I meet with my patients with the parents in the room, a lot of the moms and dads will say that the things their children are suffering they endured in silence. Now 25 years later, we are just more alert to the problems suffered by every generation.

For a long time our clinic was strategically situated near a hospital that is now no more, and had been adjacent to wonderful obstetricians who have since left. All are gone and the next door nursery is sealed shut. But as pediatricians, we can't afford the high rent of the new medical center so we are headed east by a few feet. This migration is not only the change of space, but it is a change in careers. Our move is recognition that we are not essential to the new highly technical, specialty-driven hospital. We could not keep up with the expensive rent and the hospital administration has other plans for even the slightest sick newborns that we had cared for and treated for the previous 24 1/2 years.

So, for us, the move is going to be a shift in the whole emphasis of our professional lives. Furthermore, while we hope to see children in the new office, now distanced from the neighborhoods of many young families, we know parents increasingly take their children to more convenient spots. If we were to try to keep up with them, we would have to move everywhere all the time to serve our patients in this fast-paced, chaotic world. We can't do that. We will just move next door.

In so many ways, health care in the past 25 years has gotten much better. My patients and I have benefited greatly from the new vaccines, surgical techniques, medicines, research and a new understanding of the human body and healing.

Besides, in my new office I get windows.


Joseph Cramer, M.D., is a fellow of the American Academy of Pediatrics, practicing pediatrician for more than 25 years and an adjunct professor of pediatrics at the University of Utah. He can be reached at [email protected].