Marcus Welby is an Establishment Quack!
A new generation of doctors is forcing the medical profession to examine itself.
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So at that crucial point in the summer of 1968, three important factors forced the school and therefore its graduates in new directions. Similar factors were operating at med schools all over the country.
First, DeBakey was gathering together a new board which would back up his commitment that "the school's policies should be established by the faculty." DeBakey persuaded an array of Houston business and industry superstars to serve on the Board of Trustees. Men of impressive talent, power and wealth. Presto. Baylor the church-mouse turns city slicker.
Second, there was a national trend for medical schools to streamline and modify their highly structured, relatively, inflexible, four year curriculum and to recruit minorities. This trend was reflected in a new availability of government grants for these ends. At the same time, Texas was clamoring for more doctors and it looked like the state Legislature might sweeten the pot for Texas' only private med school if it would increase its enrollment. It did.
Finally, the students who had just entered Baylor, like their contemporaries throughout the country, began protesting the rigidity of their curriculum and the policies of the admissions committee which they said were exclusionary, if not racist. They complained bitterly about shortcomings of their training, noting particularly their inadequate exposure to community medicine.
In short, they raised hell. At a school long accustomed to crew-cut, conservatively dressed students, not a few faculty were appalled at the sudden appearance of hirsute fellows in sandals and overalls, T-shirts and jeans, at their lectures. One professor who three years previously had been heard to tell a med student in a sports shirt not to return to his lecture until he was "properly dressed in coat and tie" relented over a few months' time to the point where his one demand was "you have to wear shoes!" So the brief clothes hassle was gradually solved by the tacit understanding of all concerned: students dressed as they damn well pleased for lectures but "looked like doctors" when they started seeing patients.
Attitudes about curricula were not changed so quickly. Students took the initiative, forming their own committee which was given official status by Dr. DeBakey. Their recommendations eventually led to the present flexible curriculum, which includes off campus electives of such variety that in a fit of whimsy one sometimes wonders, did these fellows take up medicine to heal the sick or to see the world?
Take Ralph Dittman, for instance. Dittman, 26, a Harvard graduate from Goose Creek, Texas, arranged his elective last year in Central America through Amigos de las Americas, a youth-oriented voluntary agency set up to supervise immunizations and health clinics, particularly in Guatemala and Honduras. Dittman says he spent the three months before he left gathering some $20,000 worth of drugs plus basic surgical equipment, most of which he got from drug companies.
Dittman travelled from one village to another setting up clinics and teaching local villagers to suture lacerations. He says his experience in Central America strongly influenced his decision for a surgical residency.
"I really saw down there the quantum leap from medicine man to surgeon," he says, adding "I did a lot of surgery myself. I amputated a lip, an ear and two fingers. My rule was—if it looked like cancer, I cut it off."
Juan Campos, who graduates from Baylor in 1974, also designed his own off-campus elective, which turned into a kind of campaign. But let him explain:
"My freshman year," says Campos, "I made several trips to South Texas with two of my professors from med school who were doing a health survey among the migrant workers there. Jose Garcia [another Baylor student] and I were observers and interpreters. The people in those communities kept asking Jose and me 'what are you going to do about our health needs?'"
Although Campos claims he and Garcia were "young and scared and our approach was conservative—we said 'be patient'"—as soon as they got back to Houston they began talking with their professors about developing a student health project in South Texas. That was the beginning of what is now a credit elective at Baylor, known as the South Texas Health Project.
Some med students, led by Campos, wrote 150 physicians in the area—(50 responded)—exploring the idea of setting up a program which would benefit the doctor, give the student experience and help the community. Now that the project is off the ground, Campos says, several doctors have decreased their work loads considerably by delegating work to students. At the same time, students are encouraged to acquaint themselves with and to mobilize community resources—perhaps taking an evening to discuss things like nutrition, drug abuse, breast cancer or dental hygiene with small groups. Students also work with youth groups in an effort to recruit young people to enter professional health fields.
Campos shares a feeling with many of his activist classmates that students really do need exposure to clinical situations away from the large medical center and city hospitals where patients tend to be "treated like cattle...where we don't worry about their transportation or their income or the problems of their personal lives...we don't really learn medical and social ethics."
With this opinion Ted Simmons, senior student and president of the Baylor chapter, Family Physicians Students Association, thoroughly agrees. Simmons says he first realized what family practice was for him when he took an elective with a general practitioner in Houston. That doctor, says Simmons, took care of the patient totally and referred to specialists only the few problems he couldn't handle. Even then when he referred a patient, he stayed in touch with the patient and his consultant and usually continued to manage the patient.
That was quite a different experience, Simmons says, from his training at a Texas Medical Center hospital where, for example, he saw a patient with pulmonary disease referred to four different consultants for problems which one man could have handled.
"There was a dermatologist called in first—I could have diagnosed and treated the athlete's foot myself," says Simmons. "Then there was a psychiatric consultation to evaluate the patient's depression—but the poor fellow had lost his job because of his shortness of breath and he just needed some understanding from his doctor. An endocrinologist was called in to treat the man's diabetes—that's easy enough to treat. The doctor I'd worked with saw all these things and treated them himself. The medical center doctors were always disease and crisis-oriented instead of being people-oriented."
Simmons started a Family Practice Club at Baylor made up of students who were thinking along the same lines. The club, which has grown to 60 members within a few months and an affiliate group across the street at the University of Texas med school, recently arranged their own teaching sessions—a 12-lecture seminar, the first of which was a panel of general practitioners (G.P.'s) from four different geographic and socio-economic areas describing what they do in a typical week.
Simmons explains the difference between the G.P. and the family practitioner by saying that the old G.P. had only one year of residency after four years of med school, which qualified him for 75 per cent of the problems he would handle. The family practitioner, says Simmons, will be trained to handle the other 25 per cent as well. He will have at least three years of residency training. Baylor is one of some 50 med schools throughout the U.S. to set up Family Practice departments recently. Family practitioners may become board certified, in which case they are required to be recertified every six years and to take a minimum number of hours of continuing education.
If Ted Simmons sounds different from the med student of ten years ago, how about Mike Hemphill? Hemphill, 25, who graduates in June, 1974, is taking a whole year, for which he will receive one quarter's credit from Baylor, at the Harvard School of Divinity in Cambridge, Mass. He is taking an interfaculty program in medical ethics which exposes him, he says, to ethical theory—such questions as "What are human rights?" "What is good?" and the legal side of human rights and health—the rights of women, or of the foetus, for example.
Hemphill attends ethics rounds at the Children's Hospital in Boston where specific cases are discussed.
"There the doctors discuss cases," he explains, "where there are conflicts of values. For example, a doctor may encounter parents who don't want to take his suggestion. Should he pressure them if he feels it's in the best interests of the patient? Or perhaps a doctor has to decide whether a mongoloid child should be operated on or allowed to die."
Hemphill is in some ways typical of the "new student": his interests go far beyond the conventional clinical curriculum. He is, he says, more interested in the humanistic aspects of medicine—such ethical problems as prolonging death, human experimentation, genetic counselling and cloning. Some of these questions have been around for centuries, but many are the result of new technology or new knowledge. Hemphill points to experimenters who have found it is possible to manipulate behavior in animals by electrical means.
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