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by Richard P. Holm, MD
Near the end of the 1800s, the average life span of a male in Dakota territory was less than forty-seven years. This was partly because the practice of pioneer medicine was so different from that of today. Vaccinations and antibiotics were not yet available for the many infections that occurred; the treatment of severe trauma was without IV fluids and anesthesia; and the training of physicians was often inadequate and certainly not standardized. Times have changed, and the average life span has improved over the years. However, some aspects of pioneer medicine haven't changed. Now, just as then, physical trauma with lacerations and fractured bones require stitches, bone setting, and sometimes even amputation. Abscesses still need to be drained. Physicians are still stitching, setting bones, and draining puss much the same way as in the 1880s. The primary tool for dealing with contagious diseases back then involved isolation and quarantine measures. Certainly, infections such as smallpox, scarlet fever, TB, and diphtheria, which ravaged the frontier West, are not so prevalent today. However, we know that those same isolation and support measures will have to be used again if another pandemic occurs. Finally, although the content of the lectures at medical schools has changed, the later part of medical training is still dependent on the one-on-one mentoring/apprentice type of learning experience. It is during this mentoring phase when the student shadows a practicing physician and learns how to have compassion for patients. The pioneer doctor traveled by horse and buggy throughout the county to practice medicine. Despite the limited number of medical tools and medicines available to them, those doctors were always most effective by caring—I mean really caring—for the sick. Some things never change. Take home lessons: 1. Major changes in health care over the last 100 years include vaccinations, antibiotics, IV fluids, anesthesia, and the education of such methods. 2. Certain elements of frontier medicine are still happening like stitching, bone setting, abscess draining, isolation of infectious diseases, and one-on-one teaching of medical students including the teaching about how important it is to genuinely care for the patient. Watch On Call with the Prairie Doc® most Thursdays at 7 p.m. central on SDPTV and follow the Prairie Doc® on Facebook and YouTube for free and easy access to the entire Prairie Doc® library. By Richard P. Holm MD
I think it is pertinent to this week’s topic of “ask anything” to pose the question: “What does it mean to be a doctor”? This is especially apropos as a new crop of doctors will be graduating from medical school this spring. Did you know that in order to enter into the profession of medicine, each new doctor must make a serious promise? It is to profess or to give one’s solemn word to do the right thing in the name of all that is sacred, and this pledge is given in public for all to see and hear. By the way, it is this professing or promising that is the basis for the word “profession”. In an issue of the medical journal Pharos, editor Edward Harris writes about the three parts to the promise. First it has to do with valuing service to others over personal reward. That means medicine is a profession that should not be undertaken with profit in mind. I would state here that clearly most premed students do not go into medicine for profit, although there may be a few that do, and I see them as the least blessed of the profession. Next, Harris points out that as a medical profession, we should be responsible for monitoring who are ethical and competent enough to graduate from medical school, to be licensed to practice, and to continue to practice. It is important to protect the public from unethical or incompetent physicians, and that is why we have a State Board of Medical Examiners. Finally, we profess to keep the sacred trust of a valuable body of knowledge, to continuously critique, question, and challenge that knowledge, and to pass it on in order to benefit every individual patient. Passing on knowledge is what we are trying to do with our television show On Call with the Prairie Doc®. That’s a promise. Watch On Call with the Prairie Doc® most Thursdays at 7 p.m. central on SDPTV and follow the Prairie Doc® on Facebook and YouTube for free and easy access to the entire Prairie Doc® library. Have you heard the myth of Prometheus, the Greek Titan who challenged Zeus? Prometheus stole fire from Olympus and brought it down to humankind, making Zeus furious with him for sharing with mere mortals the secret of such power. Zeus punished Prometheus by chaining him to a rock. Each day, birds with sharp beaks would open his abdomen and eat away his liver, and, each night, his liver would grow back. Each day Prometheus would suffer, repeatedly punished for his gift to humanity.
There are many interpretations of the myth, but probably the most famous comes with the Frankenstein story, written by 17-year-old Mary Shelly in 1816. In Shelly’s time, science was virtually exploding with new knowledge. Modern medicine was becoming effective, illustrated by how death rates were dropping; Galvani and Volt had just discovered how a dead frog leg would jerk when connected to a battery; chemists were showing how ether and nitrous gasses could make people stay asleep during surgery; and biologists were on the verge of realizing how microscopic bacteria cause contagion and fever, and how cleanliness could prevent such infection following surgery. Thus, it is understandable why Shelly would create her famous story about scientist Victor Frankenstein. Like Prometheus who brought fire to mortals, her mad scientist brought life back to something once dead using newly discovered breakthroughs in electricity and chemistry. Shelly imagined how a mortal with scientific knowledge could create a superhuman being out of body parts stolen from a graveyard. However, such a discovery should require responsibility and careful safeguards. Like fire that can jump its boundaries and spread destruction, creative scientific experimentation could quickly get out of control and cause monstrous harm and havoc to people and the environment. One cardinal rule of ethics we are taught in medical school demands: “first of all, do no harm.” Most every significant advancement in science has a potential good and bad side. Consider how nuclear power can produce marketable energy and yet can cause explosions of mass destruction; how antibiotics can treat life-threatening infections and yet can cause life-threatening overgrowth diarrhea illnesses; how advancements in genetics can cure a chronic disease like hepatitis C yet can potentially cause harm to our society’s ability to afford health care. Indeed, great advancements in science can do tremendous good while still having the possibility to cause potential danger to public and environmental health. Thus, the Greek myth of Prometheus and the monster story of Frankenstein both speak to us today. As we seek to advance science, we must understand the ethical responsibility of safety. First of all, do no harm. This ancient wisdom often rings so very true: “You only teach by example.”
We all have mentors in our lives, people who serve as examples, whose patterns of living teach us how to face challenges. Of course, most of us start out with our parents as mentors, and then look to other relatives, teachers, partners, and heroes in stories worth emulating. Even before my medical training, I watched and learned from our family physician, Dr. Bob Bell. I remember how his interests outside of medicine were very broad, including hunting and fishing, water skiing, sailing, playing cards, singing in the choir, enjoying art, etc. Dr. Bell and his wife Phyllis gave me a sense of how a superb physician family can enjoy and savor every moment of life. I watched Dr. Karl Wegner, a Pathologist, lecturer, and the first dean of our South Dakota Medical School, as he taught through empathy. I remember how he made every one of his students feel like he was speaking directly to him or her. Dr. Wegner gave me a sense of how a superb physician values the other guy. I watched Dr. Joe Hardison, an Internist at the VA hospital in Decatur, Georgia, whose diagnostic acumen and skills were famous among residents. I remember how he cleverly examined his patients, looking for subtle clues that would allow him to make a correct diagnosis. Dr. Hardison gave me a sense of how a superb physician uses her or his senses and brain to make a diagnosis. I watched Dr. Keller, a cancer specialist at Emory Hospital in Atlanta, whose caring way remarkably helped cancer patients deal and cope with incredibly ominous conditions. I remember how he confidently listened and spoke with consoling words and eyes to those with widely spread cancer. Dr. Keller gave me a sense of how a superb, compassionate, physician gives relief and exemplifies medical ethics in action. And I watched Dr. Bob Talley, a Cardiologist and former Dean of USD Sanford School of Medicine, whose concern for students and residents elevated our medical school to the some of the highest standards of training in the country. A specific example is how he helped mold a new method of integrated training in South Dakota, which Harvard has since copied, and which is also catching on throughout the country (our present Dean, Dr. Mary Nettleman is following through and expanding on this wonderful direction). Dr. Tally gave me a sense of how a superb physician, one who concentrates with all of his soul on helping young physicians learn, can result in an elevated quality of care by administered by his students to patients around the world. We only learn from and teach by example. |
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