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Page 17 text:
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The New P.C.O.M. Journal Of Medicine Copvright 1972, by Synapsis Staff Volume 1 June 4, 1972 Number 1 CLINICAL MANIFESTATIONS AND CURRENT STATUS OF RESEARCH INTO THE CAUSES AND PROGNOSIS OF INSIDIOUS LOSS OF IDEALISM D. Bruce Foster DO. Abstract: Four ears of medical school are guaranteed to change a person ' s way of seeing things. Four years ago one hundred and twenty-five students entered the freshman class at P.C.O.M. with many different conceptions of what a physician was and what the process of becoming one en- tailed. Having completed the process of becoming physi- cians, we realize that in doing so we have lost many of the values that we had ascribed originally to the title we now hold. Hopefully, it is not too late for us to re-evaluate our roles in life and to return to the idealism that led us to the profession we have chosen. Medical students are a diverse lot, with varying profes- sional motivations, and no special attributes of altruism can be conferred upon them as a group. Nevertheless, it is prob- ably safe to say that, in our naivete, many of us came to medical school with grand ideas of selfless service to hu- manitv. In the course of events that characterize medical education, we gradually increased in sophistication and, without a great deal of handwringing, discarded those ado- lescent, pre-professional illusions of dedicated service in the ivory tower. Among other things, we came to realize that: 1 ) patients are often a wretchedly ungrateful and belligerent bunch, occassionally approaching the point of being a pain in the ass 2) the public is out to get us, not to mention the administration 3) it costs a great deal of money to eat, pay for malpractice insurance, buy yachts, build swimming pools, etc. 4) attendings are seldom pleasant telephone con- versationalists at four o ' clock in the morning, even if our sparkling diagnostic acumen has detected as stole in one of their patients 5) alcoholics at 48th Street are there to keep up the census — not to be treated 6) junkies — hepatitis or not — are not eligible to keep up the census. Any of these unfortunately encountered realities have the subtle and persuasive ability to make short work of idealism, and cause us to defensively and angrily do some hasty re- structuring of the values we carried with us to medical school. Understandable as this reaction may be, we have done ourselves a disservice in allowing it to take place. Old-fashioned as the theme may be, avarice and self-in- terest, resentment and suspicion have crept into our hearts and are doing their work. They are crowding out the little acts of unrewarded service that gave us so much satisfaction in more idealistic days, and made us so much more human — the simple things, often unnoticed, that were in reality acts of love. Taking an extra moment to answer a puzzled look on a patient ' s face, relinquishing sleep to make sure an old wino at 48th Street makes it through the night, listening, after the blood tests and the urinalyses, to the personal tor- tures of a pregnant 16 year old — all small acts that bring big dividends in personal satisfaction; acts that give mean- ing to our lives and bring peace to our spirits. These demonstrations of acted out idealism have made a gradual and discreet exit from our life style as physicians, or perhaps, for some of us they never existed. At an rate, a swing of the pendulum toward our old adolescent idealism would certainly help the public to distinguish doctors from business men, and would undoubtedly make all our lives a little bit richer.
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Page 18 text:
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AN EXPLOSION OF THE MYTH THAT DEPICTS THE PHYSICIAN AS AN ORACLE AND HEALER S. L. Burnstein DO Abstract: An one who is a physician or is in the process of becoming one sooner or later realizes that part of what is- called the Art of Medicine is the illusion that surrounds the physician-patient relationship. The physician is the pos- sessor of a mystique in the eyes of his patients, whether he wants to be or not. Traditionally, it has been a widely held concept that the illusion of physician omniscience is an im- portant part of a successful practice. In view of the changing public attitudes toward the medical profession, perhaps the time has come for a more complete honesty on the part of both physician and patient. The first step in bringing about this mutual honesty is the responsibility of the physician. As today ' s new physicians, the decision to take this step or not rests squarel on our shoulders. Quite soon, we will have completed medical school. We will be thrust into a world of ailing people who come to us in order to be cured. This is the reason a sick person comes to a physician — he wants a swift answer in reference to both the disease that is afflicting him and the manner in which it can be remedied. Most patients will accept no less than a cure and the majority of physicians aim at the goal of pro- viding one. Or, they attempt to alleviate the patient ' s com- plaints in cases where a cure is precluded. No one knows when this peculiar relationship between patient and doctor began. Actually, the date of its inception is unimportant. What is important is the fact that this unfor- tunate situation has developed. And, what is more unfortun- ate is that it has been perpetuated not only by physicians, but also by their patients. As far as doctors are concerned, it must be said that many, if not most, desire to be looked on as mystical, magical, all- powerful healers. To create and sustain this illusion, a bar- rier has been erected between themselves and these sick people that come to them for cures. This barrier can easily be recognized as medical acumen. The physician is the pos- sessor of knowledge that the patient does not have. Using this knowledge to effect cures, the doctor has been success- ful in gaining and maintaining his exalted position in society referable both to favorable recognition and monetary rewards. On the other hand, the patient also helps to perpetuate this singular relationship; he perpetuates it in that he allows it to exist. He, in fact, continues to play the role of the sick patient who wants nothing more than to be well and free of disease. Or, perhaps he believes that a cure is his justice in view of the physician ' s uncondescending position as the product of a medical educational system which has been shrouded in mystery as far as he, the layman, is concerned. Sick people must believe that doctors are capable of cur- ing them — why else would they seek medical help? In ad- dition, people certainly realize that some physicians effect more cures than others. However, at the crux of the matter is the fact that people, sick or well, reverently behold a physi- cian as if he were a god or even the God — one who is cap- able of giving absolute and immediate answers ' to bring about their cures. If more people understood the manner in which medical education is dispensed and gotten, it is a certainty that the unique relationship between patient and doctor would begin to assume a different form — that of a person to person in- teraction and not a God to man experience. It is not outlandish to cite the fact that much of what a physician learns during his formal medical training depends on his own motivation. Further, taking into consideration the present capability of the human mind and the enormous compendeum of medical facts, it remains virtually impossi- ble, as well as impractical for the doctor to become anything more than a sophisticated guidance system ' — one who efficiently utilizes the medical knowledge that is his in order to treat a patient. Or, should we, as physicians, continue to sustain the illusion that, medically, we know all and can do ill, securing ourselves in this manner? Physicians should not believe that it is incumbent upon them to provide immediate cures for their patients. By the same token, neither should patients expect or demand swift cures. A physician should be thought of as an individual who is capable of approaching the medical problems of his pa- tients in a logical and sophisticated manner, utilizing what he has gleaned during the course of his medical training in order to help the sick. He should never attempt to deal with all the problems superficialK for the mere sake of hav- ing delt with them. Let ' s stop thinking of medical care as a commodity that deserves to be delivered with the same speed as today ' s milk. Further, let ' s descend our thrones and knock down the separation barriers that are serving to protect only our- selves. Let ' s start putting our medical knowledge to better use, employing it as more than an object that segregates us from the rest of the people in the world. Concerning the mode in which physicians should be judged by their patients. Dr. Lawrence Weed, renown medi- cal educator, sums the problem up well: ' we should not as- sess a physician ' s effectiveness by the amount of time he spends with patients or the sophistication of his specialized techniques. Rather, we should judge him on the complete- ness and accuracy of the data base he creates as he starts his work, the speed and economy with which he obtains patient data, the adequacy of his formulation of all the problems, the intelligence he demonstrates as he carefully treats and follows each problem and the total quantity of acceptable care he is able to deliver. ' REFERENCES 1, Weed. Lawrence L.. M.D.; Medical Records. Medical Education and Patient Care; Pubii.shed b The Press of Case Western Reserve Uni ersit , Cleveland, Ohio, 1969, 1970, p. 43. 2. Weed: p. 4.3 3, Weed: p. 100 4. Weed: p. 101
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