[Medicine-for-people] Evolution of a Doctor
Douwe Rienstra
medical at olympus.net
Thu Mar 6 11:24:42 PST 2008
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Medicine for People!
March, 2008
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Contents
Evolution of a Doctor
- "We Loved Him Just the Way He Was"
- Regrets and Objections
- Finding Dr. Welby (Where You Wouldn't Expect)
- The Kiss of the Spider Bite
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"In the measure to which I think and speak not from my own individual
conviction but simply repeating what 'is said' and 'is thought' my
life ceases to be mine, I cease to be the supremely individual person
that I am, and I act on society's account." Joes Ortega y Gasset (in
my twenties, my favorite quotation)
=== Evolution of a Doctor ===
= "We Loved Him Just the Way He Was" =
I am a young medical student at Duke University observing a team of
pediatric cardiologists in the cath lab. A small, frightened child
bawls. Beside him the pediatric cardiologist sits patiently with his
stethoscope on the tiny chest. In the silence between the child's
cries, he calmly describes the sounds made by this diseased heart. "A
systolic murmur, loudest at the base, probably from the aortic
valve. A constant murmur left back, probably a patent ductus
arteriosus. Some stenosis of the pulmonic valve."
I admire these pediatric cardiologists immensely, knowing I'll never
attain their degree of skill. These guys really are exceptional.
To pinpoint the defect, the doctors insert a catheter into the
child's groin and thread it up to the heart, inject dye and take a
very rapid succession of x-rays. The procession of film cassettes,
each one a heavy metal frame holding a piece of X-ray film, sound
like an airplane or a machine gun, a complicated loud chattering
noise from two streams of film cassettes rattling down their metal
tracks to the exposure points behind and beside the small patient.
With the clattering beating around us, all eyes focus on the various
monitors. Suddenly one monitor shows the heart rate dropping
frighteningly, from 120 down to 80, to 60, then to nothing. Pushing
the equipment out of the way, six doctors bend over the tiny body,
calling for medication, pressing on the little chest, and glancing at
the line staggering across the monitor. They work frantically to no
avail. Finally they give up. The child is dead.
I walk out in the hall with the cardiology fellow, a woman, whose job
it is to take the terrible news to the parents. The mother is grief
stricken. She sobs in the hallway.
"I'm sorry, Mrs. Ashton, but we did everything we could."
"Why did you do it? There was nothing wrong with him when you
started." She is wailing, her sobs echoing down the hall.
"Please, Mrs. Ashton, not so loud. His heart was diseased. He
couldn't play, or run. Unless we discovered what was wrong and
repaired his heart, he would never have grown up at all."
"We loved him just the way he was, why did you have to do
it? There was nothing wrong with him, he was good the way he was"
I was used to seeing patients who stoically and without question
accepted the doctor's wisdom; all this noise in the hallway surprised
me and the cardiology fellow. All that I admired in the cath lab -
the impressive X-ray apparatus, the high tech skills, meant nothing
to this mother. As far as she was concerned, we'd killed her child.
In the past 30 years since I stood in the hall listening to the
mother's loud sobbing and sensing dimly that the balance between
technology and humanity was out of whack, medicine has changed and I
have changed. Sometimes people ask me how I came to be the
independent-minded doctor that I am. In this month's newsletter, I
tell about my medical evolution, starting with my beginnings as a
young, wide-eyed idealistic newly-minted doc.
= Regrets and Objections =
For some time after I graduated, I regretted having attended medical
school. True, the professors were usually dedicated and kind, but
the system as a whole seemed lacking.
How it seemed to me in the early 1970's was this:
Doctor-centered medicine: For all my professors' curiosity and
attention to detail, they did not always listen to what the patient
was saying or appreciate what the patient was going through. Some
people call this "medico-centrism," the idea that sick people eagerly
await the doctor's next pronouncement and have nothing they'd rather
do than agree and be grateful, regardless of any ill effects.
Over-emphasis on technology: Here's an example. I could tell from a
physical exam when a patient had pneumonia, but I was supposed to
order a chest X-ray and blood tests anyway. Those tests can be
lifesaving if a case is grave or complicated. They are not necessary
in many cases I saw and still see on a regular basis. With my
thrifty Dutch background, this lack of concern about cost to the
patient bothered me.
Inaccessibility and arrogance: My partner in Milwaukee made every
patient who telephoned him at the office wait on the phone at least
twenty minutes. We had five lines and all five buttons on the phone
were usually flashing with patients on hold waiting to talk to
him. Once on the phone, he spoke as if he had just come out of a
burning building and had to go right back in again to save another
life. About once a week he felt like chatting, so he'd come into my
office, sit down and, despite the flashing lights on the phone, the
full exam rooms, the full waiting room, talk as if we were on the
golf course and he had all the time in the world. Whatever the
reasons, doctors were in a hurry with patients, the result being an
occasional missed diagnosis or ill considered treatment. All the
expensive tests could not make up for this.
Bias towards intervention: Although the physiology classes in
medical school touched on the body's natural healing systems, these
were often ignored when it came to treatment. In the delivery
suites, for example, the process of birth was attacked as if the baby
were an enemy who wasn't coming out without us going in after it.
Narrow-mindedness: Mainstream medicine seemed arrogant. My
professors expressed the opinion that no other medical methods were
worthwhile, yet as far as I could see they knew nothing about
botanical medicine, Native American medicine, Chinese medicine, or
anything outside their own narrow sphere.
Ignoring Self-Care: In mainstream medicine little attention was paid
to the health of the physician. How, I wondered, could physicians
help their patients with their mental and physical well-being when
they paid so little attention to their own? And patients asked in
vain for advice on how to take of themselves. Unless they were happy
to pay to hear the doctor say "a healthy diet and more exercise,"
they were likely to be disappointed.
= Finding Dr Welby (Where You Wouldn't Expect) =
I came out of med school in the late 1960s, a time of reexamination
of the previous generation's values and I was very much swept up in
that rebellion. My disillusionment outlined above led me away from
medicine for a time. I didn't want to use the cookbook given me in
medical school. If I couldn't be Dr Kildare, Ben Casey, or Marcus
Welby, I'd sail off into the sunset instead. You can read more about
"The Long and Winding Road" in a previous
newsletter (http://www.rienstraclinic.com/newsletter/2007/2007June.html).
By the time I came back to medicine, I had learned to meditate and
found it valuable. As Rabindranath Tagore writes, "The mind all
logic is like the knife all blade. It cuts the hand that holds
it." For me, meditation was a wonderful handle. Too, during my time
off I'd done some reading about herbal medicine. I took some courses
in polarity therapy, an early combination of Ayurvedic medicine and
touch therapy. To my amazement, much of this had some beneficial
effect, even for serious problems such as asthma. My friend Fritz
Smith, MD, who practiced acupuncture, collaborated with me. He had
developed his own technique of bodywork called Zero Balancing
(http://www.zerobalancing.com/) and taught that to me. One evening
in the hospital, a nurse complained about a severe back-ache. In a
treatment room I gave her a five minute treatment that totally
relieved her back pain.
At the same time, I discovered a joy in using the skills I had
learned in my training. I might not be Dr Welby, but I could do what
was possible and bring comfort. I was drunk, both on conventional
medicine and on all the new things I was learning. Rejuvenated, I
recognized the rough jewel I had been given at Duke Medical School.
= The Kiss of the Spider Bite =
There was one major problem. The docs who hired me to join their
practice were not similarly enthused. While one seemed interested in
acupuncture and meditation, he thought I went overboard to recommend
it to patients instead of anti-depressants or Valium. When I gave
patients unconventional advice, they weren't happy.
I remember one woman who came in with a red spot on her forearm. I
questioned her, examined it, and told her that she had a spider
bite. No worries, there was nothing we needed to do. It would go
away on its own. She got angry and said "You mean I came in here and
paid for your office call, and you're not going to give me any
treatment?" I looked at her, I looked the bite, and I lifted her arm
up and kissed the bite. Now, in this day of HIV and gloves on all
the time, I know that sounds nearly suicidal. Back in those days,
however, while we wore gloves for surgery, we didn't have all the
infection control practices we have now. Anyway, the patient
laughed, as I recall, and seemed content.
Another time, a woman had a mild vaginitis. There was no evidence of
infection, so I recommended a comfrey douche, something I'd seen work
most of the time. She didn't have any access to comfrey, so I gave
her my address and suggested she stop by and ask my wife to give her
some from our garden.
A day later the senior doc in the group called me into his office and
fired me. He'd heard about me kissing the spider-bite, he was
unhappy with my practice in general, and he was incensed that I had
some teenager out at my house practicing gynecologic medicine without
a license.
Now, there was a simple explanation, but it took me a day or two to
piece together what had happened. My wife and I were quite taken
with meditation, so much so that we occasionally provided room and
board for the local teachers and let them use our house as a
meditation center. They had helpers to check the meditation practice
of those who had learned. Having no study or other private rooms in
our house, they used a bedroom to teach and to check meditation. One
of those young helpers was checking meditation on the day my patient
stopped by for her comfrey. She arrived to find the front door open
and some people sitting on the couch, so she sat down too. The
helper finished checking one meditator's meditation, walked her out
from the bedroom, then beckoned to my patient, saying "come in, let
me check you." The patient, by now probably wondering if a simple
medical consultation had run seriously off the tracks, concluded the
young man wanted to give her a pelvic exam in the bedroom. He looked
about 18 years old, and she'd already had one today, thank you very
much, and what the hell was going on here. She drove back to the
office to explode about all this to the senior doc.
Hence my getting fired.
As it happened, a month later my senior colleague had a heart attack;
they called me up and asked if I'd come back to work. Within days I
was back to practicing medicine - my way, not theirs.
This newsletter has already exceeded our usual length, so let's leave
our story in Watsonville, California in 1975. Next month I'll share
some more about my voyage though the jungles of alternative medicine,
and how I came to the views and practices I use today.
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=== Recent issues of Medicine for People! ===
February, 2008 Diagnostic Testing; Healthy Lifestyle Support Group
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January, 2008 Love Your Colon; Honor Your Anus
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December, 2007 What I Learned in
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November, 2007 How to Talk to your Doctor, Winter and Vitamin D,
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September, 2007 Perscription Medicines: When to Use them, When to
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August, 2007 Resist the Hype, Summer
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July, 2007 Annual Pharmacy Update, Free Pharmaceuticals, Medicine
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Medicine for People! is written by Douwe Rienstra MD, edited by
Carolyn Latteier, and published at Port Townsend, Washington.
Copyright March, 2008.
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