Does Medicine Really Work to Cure People?

Does medicine really work to cure people anymore? How can we do better? I’ve said before in public, “I’m angry and I can’t take it anymore.” I can’t believe it’s been 36 years since some good folks in France buttoned a black scarf trimmed with white bunny fur onto my shoulder and told me I was now a physician, with all the rights and privileges associated with that exalted profession.

I had made it known to those in power that the Hippocratic oath, steeped in tradition, was precious to me.  So special arrangements were made.  They even gave me a special edition that did not include the prohibition of abortion, as in the classical French (Catholic) edition of that document.  They announced that it was not legally binding in any way shape or form, but they knew I had been considered almost an authority on the history and tradition of medicine.  It is doubtless lost, and certainly not with the official documents my husband has on the computer, like my clean records with licensure boards and states and insurance panels. But I cannot forget the moment I took it, when the three preceptors who passed judgment upon me kissed me both cheeks.  I stared at that paper, with artfully (if primitively) hand drawn cartoons of Hippocrates and Aesculapius and Galen, and the name “Goldstein” written on the bottom line.  Just to see my name on the page with theirs threw me for a loop.  It took all I had to hold back the tears, which I don’t think I did very well at all.

I do not know a doctor in America, other than me, who had anything like that experience. I remember years later making a copy of it for my wall, years later in Oklahoma. Somewhere it is in storage, as well as my plaque with Maimonides’ prayer for the physician.  I had a special soft spot for Maimonides, a nice Jewish boy who hung out in France a few centuries before I did, in Montpellier in the south.  Even when Maimonides was old and tired, it is said that he practiced when he could only lie in his bed, shouting out prescriptions which were written for him and then he signed them. In the last couple of years, I have seriously wondered if I have made an error, directing so many years of my life toward passing an incredible amount of examinations. As I have noticed all too often in aging, they have changed the rules to whatever game I play while I am playing it. I have been tormented by administrators, who generally turn out to be vile bean-counters, always falling short on money and space, and pressuring me to see more patients faster. I so loved the brain I studied all specialties known to me that involve it.  I generally fight losing battles with county bureaucrats who want me to see more patients faster, breaking promises and laughing. I keep moving like the proverbial Wandering Jew. I want to heal people in a system that works resolutely like some kind of athletic trainer yelling “More! Faster!

Here I am, talking and writing for a loving caring public. I have said recently that the most important thing I do is to get in a room with a person who is suffering, with a pretension of trying to heal them.  I have a computer screen before me.  They have to know if I need a detail I don’t know by heart I will find it because I care.  That is the most important thing. I am re-inventing myself, planning on age and authority to be able to do things the right way. Sprigs of hope grow eternal.  The best answer I get from people who work with other doctors is “Lots of people feel like you.”  Some of them sell books nobody reads, let alone gives to their doctors and makes them read. The way of specialized physicians has become a rarefied and distilled assembly line money generator — something I cannot and will not let others make of me. “I’m angry and I can’t stand it anymore.” There are a few voices for the passion of healing.  Strange — nurses seem to do most of the medical practice.  Specialist physicians issue lists of lawyer-reviewed orders by internet or fax, with nurses obtaining informed consent for procedures they have never seen. I remember early reports on how women physicians kept better records, had fewer malpractice suits, and the like.  I remember wishing that more feminization would somehow bring a humanization to medicine. Given the care I have received from women physicians, this has absolutely not happened. I hear from them the same terse responses I hear from men, about their limited objectives and limited scope of practice. The influx of women physicians has absolutely not humanized medicine.  It stands instead as a frightening witness to the descent of the social status of physicians.  It seems to be a less satisfying experience on a humanitarian level.  The humanitarian aspects are simply not billable. My patients generally complain about the distant, impersonal nature of their interactions with other physicians. I stand up, leaning on my duck-headed cane, opening my arms, sometimes near tears. I usually say something like”I’m really sorry you’re having such a bad time.  I’ll do the best for you I can.  Insurance hasn’t figured out how to charge for this, so the hug is on the house.” Sometimes they cry.  Sometimes I cry. Sometimes they blurt out painful insights.  Often they cry in my arms.  I have even learned to add a little extra time for this, for these are the precious moments I learn the most about my patients. One of the great things about getting older is that I never have to worry about this degenerating into an erotic hug.

I am the wise old woman, the crone, sometimes the administrator of prescription magic — but more often, I ask the obvious, “what do we have to do to get you better?  To make you love life? to make you happy?” There are more hugs, more tears.  These are the moments that make me feel better — that make me feel that maybe, just maybe, I was not wrong to study for all those exams.  A clever advanced practice nurse whom I supervised recently said “You are the huggiest damned doctor” and I smiled.  I didn’t have to explain too much to her — she got it.  Recently I have heard a couple of female voices trying to humanize medicine like Dr. Lissa Rankin. Sometimes there are male voices, too.  It is Andrew Weil who has spoken in the past of the need to study spontaneous healing.  More recently, of yoga breathing. Not long ago a man in his early thirties told me how proud I should be of my past career in clinical trials and drug development. Proud of my past?  I believe the psychiatric drugs I helped create are overused and may have created more illnesses than they have caused. How could anyone think I want to rest on my laurels?  If this is the kind of young man who seeks to enter medicine, then I am even more worried. Patients! Friends and precious readers and those who listen when I speak!  I want to know how to make you believe that I really do love you.  That I went through a particularly excruciating training long before it was fashionable to be a female member of this excruciating profession.  I will hold no knowledge back, for I want you to be informed, and will try to help you figure out how to get what you want and need from an impersonal and unresponsible medical care system that builds financial revenues at the expense of human capital. Before I found and loved my husband, I knew and loved a fairly international and very faceless human crowd.  You were my people before I met you and I loved you still.  I told my parents before I knew you that patients I had not yet met would need me, and I would belong first to them.  I was little, and they did not like the idea very much, but it has prevailed. I am still here —  this is the reason. You have my email and my social media coordinates. Talk to me.