Marcus Welby is an Establishment Quack!
A new generation of doctors is forcing the medical profession to examine itself.
I HAVE THIS FRIEND IN Houston. Let's call her Gloria. She's a hypochondriac, an incipient alcoholic and has lots of money. When she was admitted to a private hospital in the Texas Medical Center last year, she packed five sexy nighties, three flimsy negligees and two bed jackets for the trip. She swears she wore them all out.
Gloria's health is big business. Maxine, The Houston Chronicle's gossip columnist, reported her hospitalization. Specialists trooped in and out of Gloria's room focusing their opthalmoscopes on her pupils, palpating her tummy, hammering her knees and sampling her blood in such an orgy of flesh-handling that it seemed as if that TV hung from the ceiling of her room was a camera put there to record a group-grope session for The Annals of Encounter Psychology.
Gloria loved it. That is, she loved it until "the incident." I dropped in to see her that day. She had just put on sexy nightie number four; her feet were being pedicured by a beautician who makes house calls, flowers were everywhere.
"Gloria," I asked. "Are you feeling better?"
"I felt super until about an hour ago," she said, taking a long drag on her Dunhill cigarette holder. "That's when this little bastard comes marching in here saying he's a student doctor and wants to ask me some questions. He's got long hair and a beard, mind you. First he tells Jane here—who's left the beauty shop to come down here and do my feet—would she mind leaving the room. Then he's got the nerve to start asking me about how many cocktails I drink at night—implies I'm some kind of lush. He gave me such a headache I finally told him to get the hell out of my room—that I didn't want any students practicing on me anyhow."
Poor Gloria. Poor med student. It just happens both are my friends. Oh, I don't actually know which student she encountered. But I do know a lot of long-haired, bearded med students and most of them just aren't Gloria's type. I could have predicted that after five minutes of togetherness, Gloria and student would despise each other.
Oh well. Not to worry. Gloria will get her liver problem fixed up without benefit of students. And the student who interrupted her pedicure probably chalked up his experience as just another example of how "irrelevant" to his educational needs taking care of some private doctors' patients can be.
Gloria's private doctor—we'll call him Dr. Viejo—may not be the medical students' darling, but Houston Society adores him. VIP's line his waiting room. No, he's not a Dr. Feelgood type. He dispenses neither live chicken embryo nor pig testicles to rejuvenate cells. Au contraire, he's almost stuffy about playing the medical game according to the old established rules.
Dr. Viejo's credentials are impeccable. When he was at that sacrosanct medical school in the East 25 years ago, he didn't exchange words with a patient until his third year. His first two "pre-clinical" (i.e., before seeing patients) years of basic science study were two years of hitting the books all week, memorizing metatarsal bones and the rest of the Gray's Anatomy, and drinking beer on Saturday nights. He was perpetually broke well into his residency which he did at "one of the finest teaching hospitals in the East," as he usually describes it, for the magnificent sum of $125 a month plus a tiny room in the residents' quarters and all he could eat at the hospital cafeteria (residents' salaries now run between $9-13,000 a year). Only Mrs. Viejo's salary as a nurse allowed the Viejos to get married just before he completed a residency in internal medicine.
Dr. Viejo worked damned hard to get where he is today. He drives a Cadillac, sends his kids to private schools, belongs to a posh country club (admission fee more than $10,000), and though he never uses rough language in the company of ladies, he was overheard at a dinner party last month to say, "those new students give me a pain in the ass!"
"Who the hell do they think they are telling us what they need to be taught?" he said, the back of his neck visibly reddening. "The young residents are just as bad. They all want to go home at 5 P.M. and never take night duty. Why, I used to be on duty every other night and weekend when I was a resident —and that meant staying at the hospital all that time, not just being on call. I never bitched about that —wouldn't have dreamed of it. That's how I learned so much. That's why I'm a damned good doctor today. These kids want the gravy but they don't want to work. They all want to be chiefs. We've got to have some Indians, you know."
"Do you know what my interns and residents did last year?" Dr. Viejo continued his tirade. "They announced they'd all quit if I didn't let them write the order on my patients. My private patients, mind you! Then if my patients get bollixed up, guess who'll get sued for malpractice? Me. The whole thing is crazy. What ever happened to Hippocrates' idea that students should respect their teachers?"
Dr. Viejo thus vents his spleen about today's young doctors. "I'll never understand them," he says. Of course it's mutual—a sort of generation gap badly in need of sutures. Viejo is quite correct in feeling that today's typical med student is a far cry from the med student of the thirties and forties, the ones Sinclair Lewis described in Arrowsmith as "carefully dull," who aspired to a Society practice and two Cadillacs. Sure, there are still a few of those guys around. But they keep quiet about it.
The noisy ones are the activists. They complain that the teaching in private hospitals "doesn't tell us about the real world," as one of them put it. Activists are interested in new ways of practicing medicine, in how to improve health care delivery to the poor, how to recruit and train more minority physicians and how best to make ethical decisions in medicine. Those ideas never occurred to Dr. Viejo 25 years ago. He would say, if anyone dared to ask him, that he had neither the time nor the money to spend on such considerations. Besides, such thoughts weren't fashionable in his student days. Today, they are terribly in.
Furthermore, med students today aren't spending four years just hitting the books the way Viejo did. In the first place, they can complete some med schools in three years if they wish. But secondly, they're either all over the map practicing medicine in remote areas, or else staying in the city where they're getting involved in inner-city clinics or in giving drug information to kids.
Says Ralph Dittman, senior at Baylor College of Medicine in Houston, "Yes, the students entering Baylor today really are different from those of us who entered four years ago. We're the last group that was screened by the old dean. We're the last to go through the old four year curriculum. You take any issue—dress, drugs, future commitment, political stands or whatever and you'll find our class is more conservative."
Dittman's view is confirmed by Dr. Edward Lynch, associate dean at Baylor, who notes that Dittman's class which graduates this June differs from the most recently entered class not only in attitudes and interest but in size (92 vs. 169), the number of women (5 vs. 21) and the number of minority students (3 vs. 16).
Baylor has, apparently, like so many medical schools, been changing fast. Up until 1968, Baylor had not a single black doctor graduate. Mexican American Jose Garcia tells minority college students considering applying to Baylor these days that during his two years as a med student he has seen Baylor evolve rapidly as a medical school that is not solely concerned with turning out scholars but is also developing into a community-oriented medical school. It has become, he says, "a sort of 'people's medical school' which has placed emphasis on medicine for the farm laborers of South Texas, the chicanos of North Houston and the blacks of the Houston ghettoes."
What happened to change Baylor and other schools like it? According to most observers, the students had plenty to do with it. In the late sixties, a rising crescendo of student discontent and a parade of departmental chairmen resignations began to signal that if Baylor did not change, it might not survive. Dr. Michael DeBakey, who took over the presidency of the school in May, 1968, and who engineered many of the controversial changes which followed thereafter, (including the separation from Baylor University and the Baptist General Convention of Texas), puts it rather mildly, "Before I took over, there was considerable unrest."
Another observer is more specific: "Baylor in those days was a parochial outfit where the Board of Trustees and the dean's office made all the decisions—no one cared what the faculty or the students thought. The Baptist influence meant not only no liquor at dinners, but worse, no federal funds could be accepted. You can't run a good med school these days without government money and who wants to work at a place where the board is calling all the plays a la Frank Erwin up in Austin?"
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