As we celebrate the conclusion of our school-year-long series "Future Docs," guest blogger Dr. Stanley M. Aronson reflects on how far medical education has come since he entered the field 70 years ago.
Dr. Aronson is a founding dean of the Warren Alpert Medical School of Brown University, a columnist for the Providence Journal, and a supporter of Rhode Island Public Radio. He shared some of the following reflections with a live audience at our recent Future Docs public forum at the Alpert Medical School on April 23, 2013. You can listen to a rebroadcast of that forum here.
Find all 10 previous stories in our Future Docs series here. And, coming soon, don't miss our one-hour Future Docs special.
The Future Docs of America
The art and science of healing has been immensely advanced since I entered the medical profession some seven decades ago. And these readily documented advances are substantially more robust than the advent of antibiotics, the evidence-based therapies, the development of newer radiographic and biochemical diagnostic procedures and the wider availability of health insurance.
Consider, for example, the typical candidate chosen to study medicine in the early 1940’s. Well over 90% were tall, healthy white males chosen more for their sense of innate leadership and conservative beliefs than for any visible signs of intellectual superiority or compassionate behavior. The medical schools of that era trained students for a life of solo practice and therefore an immersion in a profession of unilateral decision-making, impassivity in the face of calamity, aloofness, and fatherly rather than brotherly demeanor. The lone practitioner of the 1940’s found little collegiality with nurses, technicians or members of the clergy; and his guiding principle in life was equanimity in the face of stress.
In the absence of any comprehensive health insurance, the patients of that remote era were either privileged patients of private practitioners or, more likely, people bereft of any medical care and, at best, recipients of welfare-medicine principally through municipal hospital clinics, which provided competent but an intensely impersonal and discontinuous mode of care.
Prior to the impressive era of emerging antibiotics and functioning pharmaceutical agents, medicine relied principally on nature and the preventive medicine interventions to encourage cures. The anonymous third-grade school teacher and her instructions on personal hygiene and the use of the toothbrush indirectly saved more lives than a platoon of physicians.
And what did the practicing physician of the 1940’s consider his enemy? Sometimes the truth, since the unembroidered truth was too painful to share; and so many euphemisms were employed.
And finally, the most implacable enemy of this lonely physician was the imminent death of his patient. The dignity, the integrity, the final wishes of his terminally ill patient were sacrificed to his vain attempts at delaying death. Obviously then, the arrival of a program to provide compassionate care for the terminally ill, something called hospice care, was opposed by the physician of the 1940’s but fiercely advocated by the physicians of today.
- Stanley M. Aronson, MD