It Has Been Said on Changes in Medicine: 1961-1981

IT HAS BEEN SAID on CHANGES IN MEDICINE: 1961-1981 byJOSEPH D. SAPIRA* 1 . Medical journals now contain more advertisements for books which purport to teach the physician to pass a multiple-choice examination than books which will teach him to examine a patient. 2.Physicians, who were formerly encouraged to read medical journals, are now encouraged to attend lectures, despite the fact that they can read five times faster than the lecturer can speak. 3.Doctors now attempt to examine the fundi through undilated pupils. 4.Diastolic murmurs now may be considered "innocent," while systolic murmurs go "unheard." 5.Internists meet with pathologists over a coffee table more often than they meet over an autopsy table. 6.Physicians, who formerly served their patients as guides to the store of modern scientific knowledge, now may function only as gatekeepers to consultants , who in turn are gatekeepers to laboratory tests, which they, the consultants , occasionally perform and always interpret, usually correctly. 7.Previously, the emphasis of medical practice was on the personal comfort of the patient (the art of medicine) and the diagnostic attribution of the patient's signs and symptoms to the correct disease (the science of medicine). Nowadays, there is less art and science, their places usurped by managerial intervention. 8.If a patient is admitted to the hospital with orthopnea he will not have a venous pressure or circulation time determined. However, after a few days of bed rest and pharmacologic treatment, when his breathing is better, he may have reached the head of the line for his gated blood pool scan, which may be reported as normal. 9.Grand Rounds are no longer rounds, nor are they grand. 10.Obstetricians now examine neonates only in private, but openly dispense birth control products and perform abortions. 1 1 . Students of medicine, that most intellectual of all the healing professions, have in general become more anti-intellectual than most dentists. Material appearing under this title is collected with the aim of making the serious a bit less serious, the ponderous a bit less heavy, and the reading hours a bit more fun. Toward this goal we invite a guest editor of this feature for each issue. Will readers volunteer to share their senses of humor by collecting or recollecting items that have brought smiles to their faces? We invite your participation. ?Department of Medicine, University of South Alabama Medical Center, 2451 Fillingim Street, Mobile, Alabama 36617. Perspectives in Biology and Medicine, 25, 3 ¦ Spring 1982 | 479 12.Nowadays, clinical psychiatrists perform psychometric testing and clinical psychologists perform psychodynamically oriented psychotherapy. 13.The competence ethic which formerly provided both a social nexus and code of professional interpersonal behavior has been abandoned to the managerial ethic, leaving a residue of pedagogic concern with physicians' social skills as well as an overemphasis on social gatherings which constitute a substitute for that mutual sense of well-being formerly generated by the common achievement of practicing excellent medicine. 14.The writings of the medical leadership are no longer inspirational but, rather, self-serving and sometimes grotesque. 15.Chairmen do not chair departmental meetings which do not meet any longer. Intending to do good, their days are so consumed that they do not even do well. "To think that I went to Harvard Medical School so that I could count rolls of toilet paper," said one chairman after a budget meeting. 16.As deans and chairmen have become power brokers and accountants, so power brokers and accountants have become medical experts. Accordingly, the most important medical decisions are no longer made by the physician and patient in concert but rather by law-school applicants (successful or not) and other public panderers who are, by training and inclination, inept at medical matters. 17.Now, some gonococci are resistant to penicillin, some pneumococci are resistant to tetracycline, some Pseudomonas species are resistant to gentamicin, and some mycobacteria are resistant to isoniazide. Nevertheless, many certified experts in infectious diseases continue to search for the most recent broad spectrum antibiosis, reminiscent of those nineteenth-century worthies who spent the better part of their waking hours designing perpetual motion machines; or, to be more contemporary, those persons who devise, distribute...