Marcus Welby is an Establishment Quack!
A new generation of doctors is forcing the medical profession to examine itself.
(Page 3 of 4)
Hemphill's fascination with ethical problems stems in large part from a seminar he participated in last year at the Institute of Religion at the Texas Medical Center. The Institute's director, Dr. Kenneth Vaux, an ordained Presbyterian minister and professor of ethics, has long been involved in programs to make doctors ethically sensitive to a world where medical ability outstrips ethical sensibility.
According to Dan Davis, a classmate of Mike Hemphill's in Vaux's seminar, students explored just how values in medicine are established. He and five other students spent a summer elective studying decision-making in medical institutions all over the world. These students moved in pretty heady circles. Davis, for example, who had been a Russian major at college, talked to the head of the Bordenko Institute of Neurosurgery in Moscow and went also to the Max Planck Institute in Munich to see Carl von Weisaker, physicist in charge. Davis asked them such questions as "How do you decide what you do is important? How can you justify to society and to your government the money and resources your institution spends? How did you determine that you had the responsibility to do it yourself?"
"To paraphrase," says Davis, "I was asking them 'why are you so great?'"
Davis, a native of Fort Worth, graduates this June from Baylor. He goes from there into a residency in internal medicine, but like Hemphill is uncertain about his future.
While students like Hemphill and Davis have been busy at off-campus pursuits, John Rose, 25, a senior, has been staying in Houston, where he has organized and is now chairman of the drug information committee of Baylor's chapter of the Student American Medical Association.
"The first billboard I noticed when I drove into Houston back in 1969," remembers Rose, "had a picture of a man's forearm with a tourniquet and a needle. MEET THE GRADUATE. IT STARTED WITH POT was the message. That interested me—that inflammatory and incorrect message made me realize that maybe Houstonians could use some factual information about drugs."
That included the kids, who, he soon learned, were being bombarded with drug education—much of which they did not believe. Yet they had no idea of general concepts of pharmacology, things like the appropriateness of dosage.
"You know," he explains, "they had that 'if one's good, two's better' concept that's so common in our society."
Rose says that he and some friends with backgrounds in chemistry thought it would be an interesting educational project to form a group to dispense the real word from the scientific community to the public. Twelve or so of the students spent the next two years collecting factual material in the library. Each one took a subject, reviewed the literature and wrote a monograph on it. Subjects involved alcohol, tobacco, barbiturates, hallucinogens, and stimulants. Several of these monographs were later published in Texas Medicine, official publication of the Texas Medical Association, in the hope that Texas physicians might find the information helpful in dealing with drug problems.
Once Rose and his colleagues were aware of the documented facts available about drugs, they organized a speakers' bureau of med students to go to junior and senior high schools to rap with the kids.
"We had the great advantage of being associated with medicine. That gave us legitimacy," says Rose. "We could understand and transmit the facts."
"Being young and hairy," he adds, "we had credibility with the kids who often either don't listen to or don't believe older authority figures."
"We don't take any philosophical or moral line about the use of drugs; we just want them to know there are intelligent and stupid ways to use them. Also we talk in terms of all "recreational drugs"—that includes alcohol, cigarettes, coffee, barbiturates, hallucinogens, stimulants like amphetamines and drugs like quaalude."
When the visiting speakers are asked by their listeners "do you take drugs?" they always respond: "Whether I've used them or not is irrelevant to our conversation. They're illegal and I wouldn't ask you a question like that. I'm just here to bring you information."
Of course the youngsters' questions bring up the inevitable speculation of just how much medical students do use what John Rose calls "recreational drugs." Regarding drug use at Baylor, first year student Don John says Baylor is "straightness incarnate" compared to Haverford in Pennsylvania and the University of Vermont.
It's hard to get a feeling for just how much students do use drugs—estimates of marijuana use vary from 25-60%, for example—because it depends on which student you ask. As third year student Claude Manning put it, "We're just like other young people. Some of us are freaks and some of us are straight."
Why do med students need alcohol and other recreational drugs? They say the stresses are tremendous. At least four different students independently described "most med students" as "obsessive-compulsive types" who are "achievement oriented." Stresses, particularly for first-year students, are worst at exam time and just before going to Austin to take the exams for the Texas State Board of Examiners, when, incidentally, the hairy ones usually shave and cut their hair, or at least pull it back in pony tails so they won't scare off the older doctors examining them.
Several students said that stress results not infrequently in divorce (half the student body is married) and occasionally in psychiatric breakdowns. Says one third year student, "I'd say about a third of my class are getting psychiatric counselling."
With all the stresses, one wonders how students manage to get involved in so many voluntary activities such as the drug information speakers' bureau; but some students like John Rose have two and three such projects going. Roses' second project is called the Work and Study Program or W.A.S.P.
W.A.S.P. was the students' answer back in 1969 to the oft-heard excuse, "Yes, of course Baylor is committed to educating more minority physicians, but we just don't have enough applicants." In those days, there were no Juan Camposes at Baylor and an Afro was as rare as a case of diphtheria.
In early May, 1969, several medical students conceived and proposed a program by which a group of minority pre-med students would be recruited to study and work at jobs that summer at Baylor. W.A.S.P. organizers hoped that after getting to know such students, Baylor faculty would be more apt to accept their admissions credentials despite deficiencies on certain criteria. The med students also proposed that the pre-med students receive intense preparation for the M.C.A.T.'s (Medical College Admissions Test) which are to medical school what Scholastic Aptitude Tests have been to college.
That W.A.S.P. was a success despite severe time and funding problems can be seen not only because each successive summer the number of participants increased (from 18 in 1969 to 31 in 1972), but because of the change in minority students' attitudes.
Said Gilbert Blancarte in 1973, "The W.A.S.P. program kept me in Texas. When I was an undergraduate at the University of Texas, I planned to apply to med schools out of state because I hadn't heard anything good about Texas med schools as far as minority students went. The summer at Baylor made me change my mind."
W.A.S.P. is entirely student organized and administered. According to John Rose, who was co-director of the program in 1970, "it had many goals, one of which was for students from different cultures to be exposed to each other. As it evolved, we also began to realize that the M.C.A.T. is a culturally-biased exam. As we were educating the admissions committee that the test was not totally valid, we were also trying to improve the learning-study skills of the students so they could improve their scores."
Michelle McIntosh, who was co-director of W.A.S.P. in 1971, agrees that she learned a lot by being exposed to students from different backgrounds. McIntosh, who was never discouraged from going into medicine herself —her father is a Missouri pediatrician—began to recognize the problems of less fortunately situated students who aspired to practice medicine.
"When students coming out of the ghetto tell me, 'You don't expect us to back and practice there, do you?', I understand their problems now. We must solve the problem of delivering health care to ghetto communities somehow, either by drafting doctors to work there or by improving the facilities there. I for one would like to see better facilities. If the facilities were attractive and I weren't swamped with work, I wouldn't mind working in a family practice in a city neighborhood."
While McIntosh, who graduates this June, says she thinks many of her classmates will be going into family practice, one student says "it's just a fad" and another says "it's just a new idea so there's a lot of talk about going into family practice, but it's not what you would call catching on like wild fire."
In fact, interest in specialty practice is still strong and many students feel that exposure to Gloria and her ilk is a very important part of their training.
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