Need Doctors Cringe?

DPH FRANZCP, retired, Nelson

When I entered medicine more than fifty years ago, few maladies could be effectively treated. Lobar pneumonia, diabetes, pernicious anaemia, malaria and a few others. Patients with other disorders received careful medical attention while the illness ran its natural course,' unless the doctor made it worse. A warm relationship with the doctor eased the burden of serious illness for the patient and his family. Relentless killers which raged then have now vanished; poliomyelitis, tuberculosis, diphtheria, syphilis and smallpox. Childbirth was hazardous to mother and baby. There was no specific treatment for psychotic illness. Psychiatric research related mainly to taxonomy. A quarter of asylum inmates had general paresis, which killed them in a few years; today, thanks to penicillin, it is rare. 50 years ago, surgeons could treat many life-endangering conditions. They thought that physicians were pretentious tinkerers whose professional high spot was a brilliant diagnosis confirmed by a brilliant post-mortem.

Anti-medicine today: The triumphs of modern medicine have not won universal acclaim. Kind, thoughtful people, many of whom might not be alive but for modern medicine, deride what they refer to as 'the medical industry. It is seen as a fault that a patient can be cured of a dangerous disorder with only a brief contact with a doctor. There are complaints about the scientific nature of modern medicine, which are like the cockney's complaint about caviare: "This'ere jam tastes fishy". Educated people who are highly critical of medical science may embrace uncritically any form of 'alternative medicine' and readily fall for quackery. The Milan Brych saga was instructive.

Scientific medicine provokes ill-informed hostility. Some organised opposition always tries to obstruct every effective advance in preventative medicine. They vary in seriousness from the anti-fluorididationalists who may have caused avoidable tooth ache to the anti~vaccinationists who are quiet now with the eradication of smallpox from the world. Their successors today, having learnt nothing, oppose present immunisation programmes for children. Today's most deadly anti-health lobbies are probably the tobacco and alcohol industries.

Health misinformation: It is not surprising that educated and thoughtful people are medically ignorant. The news media, with a few happy exceptions, provide sensational misinformation. People are not to know that they are living through a medical revolution. 1f one believed the mass media, one might think that society is threatened by AIDS, the Dalkon shield, Tapanui flu and RSI, after miraculously surviving the toxic shock syndrome.

How doctors react: A conventional doctor may express contempt for the critic's ignorance. A doctor has had a long training in scientific medicine and has to maintain continuous self education to keep abreast. He has to run to stand still. This background makes it difficult for her or him to understand what the critic is on about with seemingly arcane complaints about the failure of modern medicine to treat the whole person. The critic sees this as doctor-knows—best arrogance. More sensitive and socially aware doctors try to meet their critics half way. They are open minded about 'alternative medicine' and may try to use its methods, such as homeopathy, acupuncture, health food and fitness fads. They feel they should spend more time talking to their patients and may practice meditation or any of the endless variants of individual and group psychotherapy whose value is unproven and probably untestable. Dedicated doctors give their spare time to attend Balint groups. Some give credence to the exaggerated claims of osteopaths and chiropractors. The response of these conscientious doctors may look like a cringe. Most doctors probably make a different and more low-key response which attracts little attention. They simply try to give medicine a more human face.

Modest Pride. A medical woman or man today can feel modest pride in the profession. They are the most privileged doctors in history. Science has given them unprecedented power to fight disease and they inherit a proud tradition of service. This was exemplified by the doctors who stayed in plague stricken London in the seventeenth century to minister to plague victims. It matters not at all that their courage did nothing to halt the disease. Today, the doctor tries to provide the patient with scientific medical care supported by a warm doctor-patient relationship. Such doctors must be commoner than critics would allow, otherwise they would not so often specifically exclude from their strictures their own doctor, who is the one they know best. Progress in medicine to date and its increasing pace justify outrageous optimism. At present 80% of all deaths in New Zealand have three principal causes: cardiovascular disease, malignant disease and injury. It is likely that injury will become the commonest cause of all deaths, as it is today for young adults. The rate of progress makes it likely that young people alive today may yet live in society relatively free from disease.

Acknowledgement. This paper owes much to two small lucidly written books by Lewis Thomas, a self-styled medicine watcher:

"The Medusa and the Snail", Penguin Books, Harmondsworth. 1981;

"The Youngest Science", Oxford paperbacks, 1985.