The Future of Medicine

June 1 1933

The Future of Medicine

June 1 1933

The Future of Medicine

WILL YOU kindly allow me a few observations anent Benge Atlee’s article. “The Future of Medicine?” do not desire to intimate that Mr. Atlee’s scheme, or some modification of it, is not to some extent laudable. But does he not show a tendency to glorify its apparent advantages and to minimize its disadvantages? Perhaps another Aesculapian dream interview may be forthcoming which will reveal future political and other trickery, and lobbying and graft, even though a “business man or two” be included on the directorate. We can only measure the future by the past and present, and we have no assurance of future perfection of the human race.

Henry Ford did not lessen the cost and increase the efficiency of his product by operating factories in every community in the United States. And can Benge Atlee deny that there would necessarily be a tremendous expense involved in the inauguration and operation of his dream proposal? Can he suggest even an approximate outlay? Of course we know the stock arguments in this connection, such as any expense is justifiable in efforts to save human lives, and that a life cannot be measured by dollars and cents, etc. Very well. I think the medical men of Canada realize that at the present time the physical and mental health of a large number of our citizens is being seriously undermined by the intense worry and work necessary to balance their budgets and to meet ever increasing taxation, even when a new baby or a diseased appendix does not supervene to make matters worse. If this be so— and I do not think it can be denied— how about a little help to alleviate this mounting burden and thus promote the interests of health?

Again, surely the venerated Aesculapius could reveal many recollections and reminiscences of his earthly career. Does he not remember the praiseworthy good he has done through his lifelong acquaintance with and understanding of his patients, their mental idiosyncrasies, their political soft spots, and generally, his long, intimate and friendly intercourse with them all of which would terminate with the operation of the proposed scheme. I venture to think that Aesculapius, were his mind fully revealed, would have a good many “ifs” and “buts” tagged on to his ladder-stepping and laboratory idealism. It may be. however, that the revelation has not been accurately interpreted by his earthly collaborator.

The foregoing sentences must not be construed as an antagonism to attempts to improve medical services. We all wish for better conditions and results in the medical field, and will gladly welcome any practical plan to further this object. However, I wish to question a few of the concrete statements of the article of April 15.

Dr. Atlee recommends the retirement of all medical men on pension at the age of sixty years, on the grounds that they have not the strength for the work, the energy to study and the “requisite openness of mind to new ideas.”

I deny all three, and especially this openness-of-mind thing. It is not so long ago that forty years was the stated age for medical execution, but it seems that our younger brothers are beginning to show some leniency. Perhaps, if we behave well and do some knee-bending, they may even be persuaded to postpone the chloroform mask for a few years longer. It has ever been the habit of youth to belittle old age, and the aged to underestimate the young, and the middle-aged have a slam at both ends. The middle-aged have had the experience of youth, and may be considered some kind of a judge of the young. But it were better to leave their seniors alone, btxuuse they have no experience, and their observations are to a large extent based upon theory and biased by self-complacency. It would lie a calamity were Canada to be

deprived of the services of a great number of its outstanding elderly medical men, and a gross injustice to the medical men themselves, even were they retired on pension.

It is unfortunate that a gifted and honored member of the staff of a good medical school should have formed such an inferior opinion of the school’s graduates, and of the ordinary practitioner of medicine generally. I opine that one, at least, of the reasons for his opinion is the statements made by patients, which are referred to him, and their general condition on examination. Surely lie knows that the patients’ statements are often unreliable, either from misconception of the attending doctor’s remarks or treatment, or perhaps, wilful misinterpretation. Most doctors have repeatedly had the experience of their patients making remarks about what the former said or did which, if true, would stamp the medical men as rank charlatans. Perhaps a specialist is prone to form a hasty opinion of the ordinary doctor, not knowing all the circumstances, e.g., misrepresentation by the patient and refusal of the patient to submit to certain treatment, etc.

Is it possible that the city doctor, and more especially the specialist, thinks that the hinterland doctor does not keep himself informed about the newer methods of diagnosis and treatment of disease, or, that he does not take advantage of laboratory aids, which in most instances are supplied free by our governments? If this be the case, I know that he is completely out of touch with the methods of work of the general practitioner, whether the latter be young or old. Surely it cannot be necessary that we should all keep ourselves informed upon all the methods and laboratory technique, etc., necessary in the development of new ideas and results for the benefit of your patients.

In nearly thirty-five years of general practice I have never met a colleague who was not only willing but eager to seek laboratory information and more experienced or specialized advice when it was deemed necessary.

We in the “sticks” generally do not insist upon fee payment in cases where budgetbalancing is seriously imperilled. I am not qualified to speak for our more favored brethren, the specialists.

When we look at the Aesculapian comprehension of the hinterland doctor’s work as an obstetrician, we behold a most amazing state of affairs. The old. experienced M.D., as well as the new graduate, must be discarded to the scrap heap. The Tom, Dick and Harry must be thrown away because, forsooth, the maternal mortality is high. And the inference, of course, is that the work in the hinterland is responsible for this. Can statistics be given to show that this is the case? I think not. It might even be determined that Tom, Dick and Harry could show results in this branch of medical science quite as commendable as that of the eminent obstetrician.

Aesculapius seems to have formed a very poor opinion of present-day medical schools and instructors when he infers that, after several years of instruction, some experience, and a fair amount of brains and common sense, its graduates are turned kxise only as Toms. Dicks and Harrys. Let us hop, however, that this phrase was used more because it is of the catch variety, and without due consideration of its pssible prnicious effect in the minds of the prospctive mothers in Canada. If the creator of the Aesculapian theory, and the medical school of which I believe he is a valued member, turn out graduates who should not be allowed to take the management of an ordinary obstetrical case, it is just too bad. both for him and his medical school and also for the general public. Knowing, however, a large number of these graduates, both old and recent, I reserve the right to believe that his opinion is not founded upn facts,

but is the result of either a gross overrating of the specialists or underrating of the new graduates' and the hinterland’s ability, or a mixture of both.

Neither must there be any surgical work done by the "sticks” doctor, because, it is alleged, he wants to operate for the “prestige and the fee." Now, I do not prefer to believe that the author of the article in question wishes to hint that operations are sometimes done by non-specialists, knowing such operations to be unnecessary. But does he not see that the laity may very well make this interpretation? And if so, it is apparent that a distinct disservice is done, both to the laity and to a large body of the medical profession. The author especially mentions appendicitis, and this disease may very aptly be taken to illustrate this point. I think we all have had numerous cases of this common and dread disease result in rupture and death of the patient, because of the patient’s relatives and friends flatly refusing surgical advice on the ground that the case was only one of stomach-ache or sprain, or because some medical man said that there were too many operations being performed. And now we will have to combat the laity’s objections because of the “prestige and fee"

element in the diagnosis and advice. Granted however, that the diagnosis is correct and the patient and relatives agree to an operation. still, the attending doctor must not operate because his object is to collect the prestige and the fee. And why not, if the doctor knows that he is qualified, even though he be not in the specialist class?

As stated before, we are always ready to seek advice from the specialist; but doing so, we are not so dumb as to expect help in every case. We are amused with his occasional schoolmaster manner, and we remember that a good proportion of deaths occur under his ministrations as well as under the ministrations of his more lowly confrères.

I have much admiration for Aesculapius and the facile pen and ability of his sponsor, but with all due respect I cannot admit the infallability of their opinions. We are all in sympathy with, and earnestly hope for, the success of any practical scheme for the betterment of medical and surgical sendees. But would it not be better to seek this object without minimizing the abilities and doubting the motives of a large body of medical men who are honestly doing the best they can, and, I think, doing it verv well? - M. R. Y., Pictou, N.S.