Philadelphia College of Osteopathic Medicine - Synapsis Yearbook (Philadelphia, PA)

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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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NOTES OF BIOLOGY WATCHER: OUT OF THE CHRYSALIS — THE METAMORPHOSIS OF STUDENT INTO PHYSICIAN Jay Barry Azneer, DO. Abstract: Completion of medical school is accompanied by a mental condition that may best be described by the term quandary . The student finds himself with a collec- tion of garbled memories of voices and images from the past, a sense of insecurity concerning the future and a sud- den propensity for deep introspection. He recognizes his own dissatisfaction with the past but looks hopefully to the future. He realizes that his education has left many ques- tions unanswered but expects that time and time alone will bring many of these answers to him. However, the ache of the unanswerable lingers. We came innocently those first few days into the institu- tion that was to be a home to us our four years through of medical education. It was not long, however, before we dis- covered that our home was not a place of humanity or hu- mility, where we would be taught independence and where mutual respect would be the currency of interpersonal rela- tionship, but rather like a cave full of stalactites and stalag- mites. A place where our teachers loomed in the dark shad- ows as if ready to pounce and destroy, capriciously if they chose, and yet capable of great beneficence — to allow us to become physicians. It was not so very long ago — a mere whisper in the giant halls of time — a lifetime removed irom us, of memories — and we see the parade of personalities, a rubber glove, danc- ing pieces of colored chalk, a pair of spectacles, two pairs of spectacles, a vision of a Teutonic warrior like some great Nordic god staring blackly and blankly into space, dismem- bered, disembodied vertebrae dancing in mid-air about the hoary figure of an old man bent under the weight of a sack of human bones slung across his back — taken all in all the remnants of those who brushed against us in passing — like things that go bump in the night. And the words — so many words — of warning and ad- vice, but mostly of fear: Keep your nose clean. Keep your mouth shut. Don ' t cut the Cat. No moustaches below the angle of the mouth. Don ' t make waves. Times moves onward slowly, but nonetheless, steadily . . . and the dark hours of one night becoming morning melt into the sunlit noon of day after day of exam after e.xam, as though sheer weight of discipline could replace lack of substance of pedagogy. But the days do pass through week and month, and even surprisingly, blessedly, through year. The stuff of school goes on unceasingly, almost unwitting- ly. The questions — innocent or malicious by turns — What is Camper ' s Fascia? What are its boundaries? Name the vessels of the anastomosis around the elbow. Where is the verumontanum? Derive Schroedinger ' s equation and explain its significance. (2 points) The lectures — words end on end, mile after mile, pounds of them, a ton, perhaps. A voice makes itself heard noisily out of the past, That ' s not medicine! Here, just know the good notes; that ' s all you have to know . . . and then sinks into the mire of the forgotten — lecture and lecturer. Reams of paper and gallons of duplicator fluid — I need a typist for Tuesday afternoon. Physical Diagnosis. Won ' t anyone take notes for Monday, O.P. P.? The lectures missed, unmet, ill-prepared — unprepared; empty hours, days of them, weeks, even months. Physical Diagnosis is cancelled this week. Attention! There will be no lab in Physical Diagno- sis next Tuesday afternoon. Metabolic Diseases has been called off today. There will be no exam in Ob-Gyn this term. The Surgery final has been cancelled by the col- lege office. Distribution during lunch nos. 4,5,7,13,15,16,21. Registration will be held Tuesday at 12 P.M. in the Auditorium for the Sophomore class. Make sure to attend and have your checks readv. But even old ways, entrenched and glorified, give way to change and old walls groan and crumble under the weight of all our common enemies — year upon year. Yet even as the old walls of faded, fading, empires crumble amidst the cries of wizened old men, cracking head mirrors, and speculae bent asunder, new ones rise to take their place on the foun- dation of old GMT tables, empty bottles of Celestone, and once fond hopes and withered dreams. ..a vision of a woman, young — youngish, her belly fat, protuberant, breasts ripe and full, her eyes full of pain and fear and expectancy. Next to her a young physician sits — pen and paper in one hand, the other resting lightly on the abdomen of the woman; his eyes not on her but on the clock on the far wall — his face a mirror of resignation and disap- pointment — knowing that this may be as close as he may ever get to touching the young life that struggles, inches from his hand, to enter this world. And thus it is that insidi- ously, invidiously, a new empire effects to build itself upon the ruins of foregoing follies. But even out of all of the unhappiness and disappoint- ments of the process called medical education, that was not truly an education, but a long and painful detour, there be- gins to emerge something which is neither unhappy nor dis- appointing. The detour ends and education haltingly begins. The long journey into night after night and day after day begins to reap a harvest — a whirlwind of excitement, un- certainty, and fear. A gripping fear that wells up from deep within us — from the bottoms of our souls. We see . . the parade of oung and old, straight or bent over, infirm, crip- pled in body or in mind, and behind them the grinning, leer- ing spectres of the twin victors in this game of life; the two partners who are destined to dance with everyone on the