University of Michigan Medical and Nursing School - Aequanimitas Yearbook (Ann Arbor, MI)

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A PROBLEM! HOW TO TRADE A HEADACHE FOR AN UPSET ATOMACH Today's modern world of communication, with its radios, television, movies and satellites, has produced a dilemma which the modern medical school must face-or fall behind in the race for education. A physician is suppose to be a pillar of the community, a well-liked, well- educated, well- rounded fusually physically as well as scholasticallyl, symbol of health and a leader of society. As society advances, there is a trend for the doctor to lose a tinge of social status. Why? In the early years of the growth of our country, before anesthesia, antibiotics and aspirin, the average doctor was basically a brace-although relatively ignorant-purger and bleeder who had just recently traded barber shears for sawblades. Nevertheless, he was a staunch leader of the town and highly respected. The main reason behind his success was the acrid odor of his office, his secret language, foreign handwriting and basically uneducated patients. His medicines, regardless of their contents, had several grains of built-in placebo working before the prescription was even filled. This was the day of eye of an eagle, heart of a lion and the healing hand. He was as close to healing on faith alone as our profession has ever come. Modern communication has changed all this. Today, we are no longer looked upon with awe, respectful fear or love. Today we are coping with the mass media television-and advertising, Patients no longer are satisfied with aspirin. Instead they want buffering, or worse yet, they want a 'fcombination of ingredients which won't upset their stom- achs, in easy to take tablet form. It does no good to explain to the patient that it is not important whether the alittle A's beat the little B's into their bloodstreams, because they have seen it in scientifically proven tests on TVO In fact, they immediately brand you as one of the uninformed because you don't belong to that group of 7 out of 10 doctors. What ca.n be done? The public is being taught faster than the medical schools can teach public health or statistics. 30

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v C 1 is . 425343- .,' ' 5 If if x Q 1' I 1' 'Y I fi Y 'Ric S When it is found, however, that after the identification and removal of the responsible allergen, a regular Dr. Jekyll-Mr. Hyde trans- formation has taken place fassuming other factors have been properly controlledl and the patient becomes calm, relaxed, con- fident a.nd energetic, then we must look elsewhere for an explanation. The fact that many of these patients improve with psychotherapy cannot be taken as proof of a primary etiologic role, one might as well postulate that all diseases which respond to steroid ad- ministration are caused by a primary lack of intrinsic corticoids. In our scientific enthusiasm over the discovery of the cortico- hypothalamic-pituitary-adrenal axis, we often tend to slight the benerable milieu interne. The miraculous personality transformations of ulcerative colitis patients after colectomy are too well known to require elaboration. The experiments in human starvation conducted at the University of Minnesota have demonstrated profound personality changes as a result of enzymatic and vitamin deficiencies. The psychotomimetics, tranquilizers and psychic energizers point to the importance of the biochemical and pharmacological environment. There can be no question that psychophysiologic disorders con- stitute an important problem in medicine, we must, however, resist the impulse of affixing this diagnosis after only a cursory investigation-with often admittedly gross tools-has failed to show organic disease. Harold R. Styler '63 29

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Doctor Kildare recommends Listerine, and Casey wouldn't be without his cure for headache, neuritis and neuralgia. Why, even the nurses, of that grand old heroic profession, know that if uhospital tested Pepto-Bismol can keep old Mrs. Arthur Murray going, then it's the next best thing to ground goat testicles. Our professional language has become public domain. Everyone knows about unsaturated fats, myalgia, midriff bulge, coronary and the deeply hidden cough center, Just think of all the linen handkerchiefs which concentrated stomach acid has destroyed on TV. Soon we will be using such terms as the drip, drip, drip of excess stomach acid ourselves. This is only part of the problem. The rest lies with the medical school itself. The freshman medical student, the wide-eyed, scared, formaldehyde-smelling pillar of med- icine, helps put doubt in the eyes of the public. Why? The freshman is the only class which gets a real summer vacation, uninhibited by research or suggestions to stay on. His freshman year is so busy, so loaded with work that he gives up the ways of normal people and forfeits the little joys of life such as women, drink and television. Instead, he chains himself to his 40-plus pounds of books and attempts to memorize, without fail, the origins, in- sertions, etc. . . .which he hopes will make him a famous doctor. All this time, he loses contact with people-and worst of all-with advertising. Then, on his long awaited vacation, he returns home, only to find that his friends and neighbors throw words and phrases which only a specialist like Ben Casey could handle. What's this! they say, You've never heard of the medicine which picks up 40 times its weight in excess stomach acid? Haven't you ever used the nasograph? It was invented by a doctor to test the effects of nasal decongestantsf' Reciting all the anastomoses of the scapular circulation, or spieling off that the lymph drainage of the breast is not impressive-that's not TV material. Casey'd never do that. Perhaps all this could be approached by the medical school in a positive manner. Couldn't we interrupt the closed-circuit TV shows in the medical school with ad- vertising? Perhaps we could cut some of the lectures out of the bacteriology-chemical warfare section, and add lectures on toothpaste. The pharmacology course could be modified to teach us how to write illegibly and talk on stomach acids, keeping regular, the blood concentration of speedy Alka-Seltzer, and other vital issues. A visiting nurse could give us much of the latest information on midriff bulge and proper posture. These are all things to be considered. The medical students of today need to come up-up to a Kool approach like that of Kildare's. The deans and staff must remember that it's who's up front that counts-in front of the TV, that is. Richard A. McConnaughy '63 31