NATIONAL SYSTEMS OF HEALTHCARE EVENTUALLY BECOME
BUREAUCRATIC, UNRESPONSIVE TO PATIENTS, AND FINALLY THEY
BRING RATIONING AND WAITING IN LINES.

AMERICANS DO NOT PATIENTLY QUE UP FOR ANYTHING,
ESPECIALLY FOR MEDICAL CARE.

101
I DO NOT FAVOR TOTALLY SCRAPPING THE SYSTEM WE HAVE
NOW;

BECAUSE OF ITS DIVERSITY, IT IS POTENTIALLY THE BEST IN THE
WORLD. AND BECAUSE OF THIS DIVERSITY THERE IS NO
PANACEA, NO SINGLE MAGIC BULLET.

IT WOULD TAKE AT LEAST SIX BULLETS, FIRED SEPARATELY, TO
CONQUER THE DISEASES AFFECTING THE UNITED STATES'

HEALTH CARE NONSYSTEM.

102
IT REMAINS TO BE SEEN WHETHER OR NOT THE PRIVATE SECTOR
SEIZES THIS ONE AND ONLY OPPORTUNITY ---WHILE THE

GOVERNMENT IS TOO POOR-- TO EFFECT SOME CHANGE.

BUT WE ALL NEED TO BE A PART OF THE EFFORT.
THERE IS NO QUICK FIX.
FROM HERE TO WHERE WE WANT TO GO COULD TAKE A DECADE,

BUT WE'D IMPROVE YEAR BY YEAR ALONG THE WAY.

103
LET ME SAY IT AGAIN, THAT THE RESTORATION OF THE DOCTOR-
PATIENT RELATIONSHIP IS MOST ESSENTIAL.

BUT IT WILL TAKE COMMITMENT BY PEOPLE ON BOTH SIDES OF
THE STETHOSCOPE.

THERE ARE THINGS WE CAN DO, AS DOCTORS,

EACH DAY WE PRACTICE.

104
I AM AWARE, OF COURSE, ABOUT THE DIFFERENCES WITHIN OUR
PROFESSION. "THE MEDICAL PROFESSION" IS NOT MONOLITHIC.
AMONG THE DIFFERENCES I NOTE IS ONE ALONG THE LINES OF

GENERATIONS.

105
I BELIEVE THE PHYSICIANS OF MY GENERATION HAVE A
STRONGER SENSE OF THE "ART" OF MEDICINE, AND TEND TO
GIVE LESS VENERATION TO THE "SCIENCE" OF MEDICINE.

MAYBE WE CONDUCT OURSELVES THAT WAY BECAUSE WHEN WE
WERE FIRST STARTING IN PRACTICE, THE SCIENTIFIC
UNDERPINNING FOR OUR PRACTICE WAS, TO BE HONEST, RATHER

MARGINAL.

106
NOW, OF COURSE, PEOPLE WANT THE BEST OF BOTH WORLDS, A
DOCTOR WHO IS UP TO THE MINUTE ON THE LATEST HIGH-TECH,
BUT HAS THE COMPASSION, CARE ...AND TIME.. OF THE OLD-

FASHIONED COUNTRY DOC. AND IT'S TOUGH TO BE BOTH.
BUT WHAT'S THE REAL SIGNIFICANCE OF THE STATEMENT THAT

"PREVIOUS GENERATIONS OF DOCTORS PRACTICED THE ART,

RATHER THAN THE SCIENCE, OF MEDICINE?

107
PRIMARILY, I BELIEVE IT MEANS THAT WE SAW MEDICINE AS A
RELATIONAL ENTERPRISE. WE ASKED THE KINDS OF QUESTIONS
THAT REFLECTED CONCERNS ABOUT RELATIONSHIPS:

HOW DID WE REACT TO PATIENTS?

HOW DID WE TREAT THEM?

HOW DID THEY RESPOND TO US?

DID WE CARE ABOUT THEM?

DID WE CARE ABOUT THEIR FAMILIES?

108
WE HAD TO BE PEOPLE-ORIENTED BECAUSE, WITHOUT THE
BENEFIT OF C.A.T. SCANS OR N.M.R.S, JUST ABOUT EVERYTHING
WE LEARNED ABOUT OUR PATIENT CAME FROM THE TAKING OF
GOOD HISTORIES .-- THROUGH SENSITIVE DEALINGS WITH
FAMILY MEMBERS.

FOR ME THAT WAS THE FUN OF MEDICINE. EVERY PATIENT WAS

A CHALLENGE.

109
TODAY, YOU HAVE ALL THAT TECHNOLOGY TO HELP YOU OUT. IF
A PATIENT IS UNCOMMUNICATIVE FOR ANY REASON --INCLUDING
THE PATIENT'S AGE --YOU'RE NOT TERRIBLY UPSET BECAUSE
YOU'LL GET MOST OF THE INFORMATION YOU WANT FROM A
VARIETY OF MACHINES, LABORATORIES, AND TECHNICIANS.

NO DOUBT THESE DIAGNOSES ARE SPEEDY AND ACCURATE.

THE SCIENTIFIC ADVANCES IN MEDICINE IN THE LAST

GENERATION ARE MAGNIFICENT.

110
THEY HAVE PROLONGED MANY LIVES. WE HAVE ALL MADE FULL

USE OF THE ADVANCES IN MEDICAL SCIENCE FOR OUR PATIENTS

AND OURSELVES.

BUT THE SCIENCE OF MEDICINE SHOULD NOT ECLIPSE THE ART
OF MEDICINE.

IN OUR SCIENTIFIC PROGRESS SOMETHING MAY HAVE BEEN
LOST ... SOMETHING VERY IMPORTANT TO THE CONTINUED
STRENGTH OF THE MEDICAL PROFESSION: THE RELATIONAL

BOND BETWEEN PHYSICIAN AND PATIENT.

111
A FRIEND OF MINE WENT TO HER PHYSICIAN'S OFFICE
RECENTLY, AND AFTER A BRIEF HISTORY WAS TAKEN, WAS TOLD,
"I'LL SEE YOU NEXT WEEK."
THE PATIENT ASKED,
"AREN'T YOU GOING TO EXAMINE ME NOW."
THE DOCTOR RESPONDED,
"NOT UNTIL THE TESTS COME BACK. MY NURSE WILL TELL

YOU ABOUT THEM."

112
I UNDERSTAND THAT SOME OF TODAY'S BUZZ-WORDS AMONG
MEDICAL STUDENTS ARE "CARING", "COMPASSION’, "DIGNITY",
"HUMANE" ....

AND THOSE ARE CERTAINLY SOME OF THE MOST BEAUTIFUL

WORDS IN OUR VOCABULARY.

BUT I'M AFRAID THEY CO-EXIST WITH SOME OTHER MODERN
BUZZ-WORDS LIKE "DAMAGE CONTROL", "DEFENSIVE MEDICINE",
"MALPRACTICE' ... TERMS THAT ARE AMONG THE UGLIEST IN THE
LANGUAGE.

THEY CONVEY THE IDEA THAT THE PATIENT AND DOCTOR ARE

ADVERSARIES.

113
INSTEAD, WE MUST VIEW OUR PATIENTS AS HUMAN BEINGS, AS
ALLIES,

WORKING WITH US IN THE STRUGGLE AGAINST DISEASE.

THIS INCLUDES PREVENTION AS WELL AS TREATMENT AND

REHABILITATION.

114
THE DENTISTS HAVE DONE A MUCH BETTER JOB IN THIS THAN
WE HAVE, JOINING WITH THEIR PATIENTS IN PREVENTIVE
DENTAL HABITS,

EVEN THOUGH THIS HAS THE EFFECT IN SOME WAYS OF
WORKING THEMSELVES OUT OF A JOB.

MOST AMERICANS REALLY FEEL THEIR DENTIST WANTS THEM TO
HAVE FEWER CAVITIES.

THEY DON'T VIEW THEIR RELATIONSHIP WITH THEIR DOCTOR IN

THE SAME WAY.

115
FOR EXAMPLE, IF OVER THE LAST DECADE, DOCTORS HAD
QUIZZED THEIR PATIENTS ABOUT SMOKING, AND THEN HAD
GIVEN SOUND ADVICE, WE MIGHT ENJOY THAT SAME ALLIANCE

IN PREVENTION.

AFTER ALL, IT HAS BEEN KNOWN FOR MANY YEARS THAT THE
MOST LIKELY CAUSE OF SMOKING CESSATION IS FOR A DOCTOR
TO LOOK HIS OR HER PATIENT IN THE EYE AND TELL HIM,
"SMOKING IS GOING TO KILL YOU." AND I HAVE NOT EVEN

MENTIONED THE LIVES SAVED.

116
TREATING OUR PATIENTS LIKE ALLIES IN THE FIGHT AGAINST
THEIR DISEASE MEANS BEING CLEARER AND MORE COMPLETE

ABOUT INFORMED CONSENT.

THAT MAY MEAN TELLING MORE ABOUT WHAT WE KNOW IN

SOME CASES, SHARING OUR UNCERTAINTIES IN OTHERS.

117
EARLY IN MY OWN PEDIATRIC SURGICAL PRACTICE, I

DETERMINED THAT I WOULD MAKE MY PATIENTS' PARENTS

ALLIES WITH ME AGAINST THEIR CHILD'S SURGICAL PROBLEM.
| AT LEneri4

I'VE SAT DOWN AND TALKED WITH THE PARENTS OF MY TINY

PATIENTS.

WE'VE SWEATED OUT THE HOURS TOGETHER IN RECOVERY.

WE'VE BEEN ON THE PHONE TOGETHER WITH COMMUNITY

SERVICES AND VOLUNTARY AGENCIES TO SEE WHAT KIND OF

HELP WILL BE OUT THERE WHEN THE FAMILY TAKES ITS BABY

HOME.

118
HAS IT BEEN WORTH IT? YES, IT HAS. .. ON MANY LEVELS.
FOR ONE THING, I'VE GOTTEN TO KNOW DOZENS OF

COURAGEOUS, GENEROUS, COMPASSIONATE FAMILIES.

I MAY HAVE HELPED THEIR CHILDREN OVERCOME SOME
DISABILITY ... BUT THEY ALL HELPED ME OVERCOME

PESSIMISM, DEFEATISM, FRUSTRATION, AND DISCOURAGEMENT .
. . FEELINGS THAT ARE COMMON ENOUGH AMONG HARD-

WORKING PHYSICIANS.

119
I DID THIS SIMPLY BECAUSE I THOUGHT IT WAS GOOD MEDICAL
PRACTICE, BUT IT ALSO HAD THE UNFORSEEN DIVIDEND OF

HAVING NO ONE SUE ME FOR 39 YEARS WHEN I WAS IN PRACTICE.

OF COURSE WE'LL BE DISAPPOINTED NOW AND THEN.
AND, DEPENDING ON YOUR PARTICULAR PRACTICE, YOU JUST
MIGHT DRAW MORE THAN YOUR SHARE OF DEADBEATS AND»

MALCONTENTS.

120
BUT IT'S STILL NO EXCUSE FOR DISCARDING FROM YOUR
ARMAMENTARIUM THE KEY ELEMENTS OF THE ART OF
MEDICINE:

THE ELEMENT OF PERSONAL ATTENTION AND INTEREST

THE ELEMENT OF TRUE CARING

THE ELEMENT OF SINCERE HUMAN FEELING

AND THE ELEMENT OF GENEROSITY OF SPIRIT.

121
AS PHYSICIANS, AS WELL AS CITIZENS, WE NEED TO DO
SOMETHING FOR THOSE AMERICANS WHO, UNDER OUR PRESENT

SYSTEM, ARE DENIED ACCESS TO REASONABLE CARE.

WHILE WE WAIT -AND TAKE PART IN FINDING REGIONAL AND
NATIONAL SOLUTIONS, WE CAN DO OUR PART BY REVITALIZING
THE PRACTICE OF OFFERING FREE CARE TO APPROPRIATE

PATIENTS.

122
IN MY EARLY DAYS I FOUND MYSELF EXTRAORDINARILY
FORTUNATE IF I GOT PAID FOR 40% OF WHAT I DID.
BUT I WAS HAPPY IN MY PRACTICE, MY PATIENTS APPRECIATED

WHAT I DID, AND I CERTAINLY ENJOYED WHAT I DID FOR THEM.

BUT ONCE ENTITLEMENTS CAME ALONG, DOCTORS WHO HAD
BEEN VERY HAPPY TO PERFORM A CERTAIN AMOUNT OF FREE
SERVICE BEGAN TO FEEL THAT THEY HAD TO BE PAID FOR

EVERYTHING.

123
I SEE NO REASON WHY CERTAIN FREE CLINICS COULD NOT
OPERATE UNDER LAWS THAT FORBID LITIGATION.
GIVING, CHARITY, HAS ALWAYS BEEN PART OF OUR CALLING.

WE OUGHT TO FIND WAYS TO DO IT WITHOUT PENALTY.

124
NOT LONG AGO, I WAS SPEAKING WITH TWO YOUNG WOMEN,
BOTH BRIGHT, KNOWLEDGEABLE, ARTICULATE HEALTH

REPORTERS.

I ASKED THEM EACH THE SAME QUESTION:

"ARE YOU SATISFIED WITH YOUR HEALTH CARE?"

ONE SAID SHE WAS;

ONE SAID SHE WASN'T.

125