DOCTOR DID-LITTLE AND
THE MODERN SCIENTIST-PHYSICIAN
by Adam Watson
The Youngest Science (Penguin Books, New York: 1995), a collection of essays about doctors, the treatment of illness and the wonders of medical technology, is aptly named. When the author Lewis Thomas (who was the son of a doctor) began his medical career in the 1930's, medicine as a science was a new concept. In these essays, we can see the comparisons between Thomas's generation of doctors and his father's, and how it changed in ways his father would have never imagined.
His father did not choose to be a doctor for the money. The popular image of today's doctors, with Rolex watches, Lexus cars and lots of idle time for playing golf would have been laughable at the turn of the century. Getting patients to pay for services rendered was very difficult. As Thomas puts it, "Very few of the patients paid promptly, and a good many never paid at all. . . . it was not the style of the time to pay the doctor quickly" (3-4). It was accepted that being a doctor was "a chancy way to make a living, and nobody expected a doctor to get rich" (4). When Harvard doctors responded to a 1936 survey, most gave the following advice: "marry a rich wife" (5-6). (This implies another change of the medical profession, of course: doctors can now be females.) Thomas's father had little free time as well. He had an office at home, having visiting hours from one to two in the afternoon and seven to eight in the evening (8). The rest of the time was spent on house calls and hospital rounds. "But it was at night," Thomas writes, "long after the family had gone to sleep, that my father's hardest work began" (9). Late into the night, people would telephone the house, often resulting in his father leaving for a late night doctor's visit.
Lewis's father also accepted another hard truth: doctors could diagnosis an illness if they were lucky, but successful treatment was practically non-existent. At the beginning of the twentieth century, doctors were more like "faith healers" (12). The "good medical schools" of the day "produced doctors who could make an accurate diagnosis and knew enough of the details of the natural history of disease to be able to make a reliable prognosis. This was all there was to science in medicine" (20-21). His father "could [not] do . . . much to change the course of [his patients'] illnesses" (13). Instead, he prescribed medicines that even he knew were useless, except as placebos. Patients, however, expected the prescriptions. "The purpose of this kind of therapy," Thomas writes, "was essentially reassurance" (15). It was the "sole technology" that doctors had to combat illness, and it gave them the appearance of doing something; "if nothing else, they gave the patient something to do while the illness . . . was working its way through its appointed course" (15).
Thomas entered medicine still stuck in this phase. In fact, his "middling fair" academic record at prep school wouldn't be enough to get into a medical school today (26). Med school's purpose was still how to diagnose and recognize disease, and treatment was barely discussed (27). A grim reality soon set in: "[I]t gradually dawned on us that we [the medical students] didn't know much that was really useful . . . [and] medicine . . . was in real life a profoundly ignorant occupation" (29). But this ignorance was not to last. By 1937, "medicine was changing into a technology based on genuine science" (32). Vaccines, antibiotics, insulin and other discoveries were just around the corner, and Thomas was on the verge of this change: "We had been raised to be ready for one type of profession, and we sensed that the profession itself had changed at the moment of our entry" (35).
The new technology made treatment possible. It also changed the nature of the doctor-patient relationship. It used to be that "talking with the patient was the biggest part of medicine," but in modern medicine, talking is sometimes not even necessary. Instead, the patient is subjected to an armada of testing machines; more to the point, the patient-person becomes a subject. If hospitalized, he or she "feels . . . like a working part of an immense, automated apparatus," an impersonal cog in the machinery of a modern medical factory (59). They are "handled as an object needing close scrutiny and intricate fixing, procedure after procedure, test after test, carted from one part of the hospital to another day after day until the thing is settled" (227, my italics); they are "less like a human in trouble and more like a scientific problem to be solved as quickly as possible" (227-228).
However, there is an important point that Thomas makes. If humans are treated more like "problems," they are at least treated like scientific problems. Thanks to modern technology, "[m]any patients go home speedily, in good health, cured of diseases" (59); in the past, this was up to luck, or hope. It would be lovely to go back to the days of house calls and long, intimate discussions with your doctor while he concernedly holds your hand. But "[t]he new medicine works" (58), something that old medicine could never claim to do. "If I develop [an illness]," Thomas writes, "I want as much comfort and friendship as I can find at hand, but mostly I want to be treated quickly and effectively so as to survive" (58).
There is something to be said for the doctors of the past, for the doctors like Thomas's father. Yet, it is difficult to believe we would give up the miraculous powers of modern medicine for a bygone era, whose doctors could often only stand by while their patients suffered and died. The best we can do is remind modern doctors that patients are people too, and since all doctors have the potential to become patients themselves, they should treat them like they would want to be treated. I believe Lewis Thomas would agree.