October 2001
Volume 65 |
Number 10
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VENTILATIONS
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That We Have Your Attention… |
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Mark
J. Lema, M.D., Ph.D. Editor
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There is a new “Day of Infamy.” September 11, 2001.
It eclipses the Pearl Harbor attack of December 7, 1941, not only
in lost lives, but in its attack on innocent people. Terrorists
have changed the world’s view of personal freedom and the
United States’ notion of invulnerability. They clearly have
captured the attention of all Americans and all of civilization.
If we think, however, metaphysically (spiritually) and reflect
on the path that world culture was following, could we not deny
that a supernatural intervention might have occurred? I do not
intend to argue religious philosophy but rather the repercussions
of such an unthinkable inhuman act. It does, however, make one
think of Satan incarnate perpetrating this faith-shaking assault
or even God displaying displeasure by allowing the forces of evil
to succeed.
Moral issues have always challenged physicians in the past. As
an example, I found a passage in a book recommended highly to
me by Richard M. Flowerdew, M.D.:
“None of us knows what is happening to our society; in
many material ways people are living more comfortably than they
have ever lived in the whole of human history. That is obvious,
and yet there are great dangers. I doubt if we have the social
insight to see how deep theses dangers are, but we can see their
efflorescence in the increase of crime and juvenile delinquency
and so on. The kind of forces binding society together are getting
very weak… Modern life is becoming entirely deprived of
any sense of community. There is no wise man, the religion which
was preached is no longer listened to.”
From “The Status of Doctors” Lecture given by Sir
C.P. Snow
at the Royal Society of Medicine, London, May18, 1966.1
Ironically, long before the “social” isolation caused
by the advent of practical computerization or virtual reality,
Snow felt the need for the medical specialty to be more than “health
care providers” to its patients.
Four days after the attacks, I had a quiet conversation with
Kurt Becker, Executive Director of the New York State Society
of Anesthesiologists. His office window on Lexington Avenue at
Grand Central Station looks south onto lower Manhattan, where
the twin towers once majestically supported the New York City
skyline. Kurt, a polite, articulate and kind person, thought that
maybe God was sending a message to Earth’s inhabitants indicating
that civilization’s development had taken a wrong turn. Realizing
that America had the wherewithal to lead the world back onto a
course of human decency and respect, a biblical message may have
been sent for humans to redefine their purpose and direction.
I had the same notion, believing that the world was becoming
a modern-day Sodom and Gomorrah with exposé media programs,
overt greed, widespread pornographic material and image-destroying
news accounts becoming prominent in daily life. Is it possible
that, in this age of technology where religion, community and
afterlife are but mere resources for the weak, poor and invalid,
Good and Evil are once again appearing in biblical proportions?
Whatever your perspective may be regarding the rationale or symbolism
of these unspeakable events, all can agree that attitudes and
core values have changed across the world. As physicians, we should
also reflect on the direction that medical practice and the doctor-patient
relationship has taken. C.P. Snow states in that same address:
“People want not only to be kept alive and working properly,
they want to be cheered, they want some sort of stimulus, some
sort of contact, they want, in fact, a leader.” 2
While we are supporting national efforts to respond to unbridled
terrorism, we can also take this opportunity to “retool”
our attitudes toward colleagues, patients and even payers. We
can reassess our perception as leaders in medicine and health.
Hopefully, other professions also will be changed by this life-defining
experience and look for solutions to current conflicts preventing
their development.
In closing, a short essay by Richard Asher, M.D., another London
physician, describes seven sins of medicine. It seems fitting
to use these general shortcomings as benchmarks for how we individually
or collectively practice.
The Seven Sins of Medicine
By Richard Asher 3
1. Obscurity: Seek clarity when writing or teaching
2. Cruelty:
Mental — Avoid saying too much, too little or forgetting
the patient
Physical — Avoid overinvestigation, excessive invasiveness
and thoughtless actions (e.g., diuretics at bedtime)
3. Bad Manners:
Toward patients — Pretend that you are talking to your parent,
spouse or child.
Toward medical staff — Pretend that you are talking to your
clergy, your sibling or your best friend
4. Overspecialization: Be a doctor first and a specialist
second (resist the temptation to start the National Association
of NSAID Users [NANU])
5. Love the Rare: Seek to find the cause of enigmatic
illnesses and not simply pass it on to another colleague
6. Common Stupidity: Use common sense, avoid therapeutic
automatism
7. Sloth:
Physical — Make the extra effort to take the blood pressure
or order the test, regardless of its apparent insignificance.
Mental — Make the effort to garner as much medical information
when taking the history — especially with the impaired patient.
It is a new time in America and in the world, and there is a
new opportunity to become active participants in daily living.
Naysayers, busybodies, crybabies, moochers, egomaniacs and gluttons
are now passé and declassé. In the midst of our
country’s darkest moment, take the opportunity to become
a player. No experience is necessary except a positive attitude.
References:
1. Ballantyne J. Bedside Manners: An Anthology
of Medical Wit and Wisdom. London: Virgin Books; 1995:30.
2. Ibid, pg. 31.
3. Ibid, pgs. 32-38.
(Because of the continuing popularity of the aphorism and
“Berra”ism editorials, I would like to continue running
them. If you have aphorisms or “Berra”isms to share,
please send them to me at Newsletter_Editor@ASAhq.org.
Previous aphorisms were run in September 2000, January 2001 and
August 2001.)
— M.J.L.
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