A Frugal Physician Prescribes
Common Sense and Enthusiasm
(scene from Shakespeare in Love)
Is There A Doctor In The House?
said that, “All the world’s a stage and all the men and women merely
its players.” Others think life is just about power, or all about love
or pleasure. What’s your take?
Being a teacher at heart, I look
at the world as being a great school. Wherever we go we meet teachers
and students. Sometimes, we teach and other times we hopefully learn.
And others, maybe we do both.
Teaching and learning is surely
happening in hospitals and clinics and medical offices. Whether they
realize it or not, physicians and medical providers are about that
business, every day. Even though much of those processes may be quite
Doctor coming from the Latin word meaning Teacher
should give physicians and patients alike pause to consider what
lessons may be learnt in medical moments.
Continue on to read
stories about physicians and some of the hidden things they may be
learning in the course of practicing medicine.Chapter: Teaching and Learning
importance of patients’ faith in their physicians brings many
intangibles - demeanor and attitudes, interests and aptitudes, hopes
and aspiration - to the fore. Know it or not, physicians are constantly
expressing their talents and prejudices, ideals and struggles while the
ply their trade and practice medicine.
Medicine surely has
components of teaching and education, unconscious as well as conscious.
The term DOCTOR comes from the Latin word for teacher. The best of
doctors are teachers and practice the premise: “Give a man a fish and
you feed him for a day. Teach a man to fish and you feed him for a
lifetime.” Unfortunately, the present system makes it difficult to
squeeze in teaching time during brief consultations.
Physician is not just an attendant of the physical form, but a teacher
in word, deed and presence to the minds and hearts and sometimes souls
of his/her patients. When that is the case, true healing among those
patients may be stimulated from time to time.
we are really about healing others, we are drawing forth the best (one
definition of education) in them and reinforcing that in ourselves. The
author, featuring himself to be a teacher, has had the chance to view
and experience many varied teaching and learning opportunities in the
course of 20 years passing through the medical profession. And, many
more in after years. Here are some which come to mind.
off, I am reminded of my brother, the Salesman, who once said to the
family minister, “You know, we are both in the sales business. I sell
signs and you sell God.”
The minister wasn’t flattered, but
certainly Brother had a point. We are all selling something; ourselves
if naught else. Teaching and selling have a lot in common.
sell themselves as well as their products (pills and operations) and
services (tests and procedures) and beliefs (based on medical
knowledge). The better the physician’s skills at teaching and selling,
the better his patient is likely to respond.
• I remember
meeting physicians whose name tags told reams about what they were
teaching and learning - consciously or otherwise.
I was still a
medical student when I got into conversation with a short brash, bulky,
red-haired man in a business suit on a hospital elevator. He acted more
like a salesman than a physician as he told stories and yucked it up.
Actually, he was a surgeon.
Before his sales pitch was over
and we got out of the elevator, he handed me his card which read Donald
Butts, MD, Proctologist. I suspect he is still in practice and selling
his service. I wonder what he is “up to now.”
• Then, there was
the cardiologist named Dr. Heart (maybe Hart). I didn’t know him
personally. I just heard bits of his story secondhand. He must have
needed more heart than some. His theme song could have been “You Gotta
You must have heard of Dr. Cutter. Of course, he
was a general surgeon. And, Dr. Blood. The hematologist. And, Dr. Crabb
who worked in oncology. (The crab is the astrological sign for Cancer
and cancer itself is frequently called the “crab” in medical parlance.)
How about Dr. Child, the pediatrician.
Emma Jordan was a nurse practitioner who worked at the ARE Clinic. She
was past 60 at the time. I can see her now. Thick hyperopic glasses,
permed and dyed short gray hair, a lilt to her voice and an often
seeming frustrated air. She waddled a bit like she had arthritis. It
can be hard to get old even for a medical person.
Emma had the
consolation of working with patients who were a lot like her. Or
certainly became that way by the time they been on her “panel” for a
Emma was obviously post-menopausal and on hormones. So
were a swath of her patients. She was hypothyroid and taking some form
of thyroxin. As were many of her patients.
Emma was always
setting up patients for glucose tolerance tests looking for
hypoglycemia which she had. There were a few other recurring ailments
like sinusitis and candidiasis on her personal and on those in her
patient panel. Emma had companions on the way with her dis-ease. Like
attracts like. Which certainly creates learning opportunities.
Medicine has other ways of teaching, some very mystical and removed
from regular eyes and common thinking. Nonetheless, mythic guardians
such as Asclepius and Chiron must watch over the comings and goings of
its practitioners. They certainly looked after me.
You say, “I
don’t believe in that! You’re pulling my leg, now.” Not so. Let me give
you something we might both agree on which may also cause you to
rethink your disbelief in medical guardians.
You must have
driven in heavy big city highway traffic and wondered more than a few
times, “How can all of these lethal vehicles charging around at high
rates of speed keep from regular accidents, injuries and fatalities?
With all the oblivious drivers, texting, phoning, lunching, radio
listening and map readnig, how do people keep from harming each other
Well, my answer is “Surely, there are invisible
Lords of Traffic which keep us safe most of the time. When our number
is up, They keep those whose aren’t out of our way. Think about it!”
there must be Teachers - Angels - Spirits - Guardians who watch over us
in our health and in our disease. They only permit that which is our
due to come to us. For, “As we sow, so shall we reap.”
is the patron of healing who carries medics through the trials and
tribulations of the profession and guides them according to their
effort and motive. Chiron has the special task of coming sooner or
later to every physician to teach him/her about mortality, pain, and
humanity. Personally and not just in the guise of his/her patients.
is the sign of the healer and wounded one. Like Gus Wood (see below),
we all have wounds and weaknesses. Until physicians grapple with them
and learn from them, their abilities to aid and heal others is surely
limited. The lessons of Chiron some day will return to the medical
curriuclum as they were centuries ago. (Patients of Job)
of us, including physicians, are constantly drawing the experiences we
need to enrich our path through life. We thus meet ourselves coming and
going. MEETING SELF. Eventually - it may take a very long time - we
learn the course of instruction ordained for us.
learner in my Family Practice residency was Dr. Gus Wood. Gus was “a
hell of a guy,” but had a “hell of a problem,” as well. Everyone smiled
at and bantered with Gus. Everyone was glad he was in the program and
in the hospital.
But, Gus wasn’t so sure about being there.
Gus wasn’t sure about anything. He lacked self-confidence and
self-esteem. He was always telling or demonstrating his weaknesses to
staff and fellow residents alike.
Wood was tall - well over six
feet - and stocky, and filled out his uniform so he looked like the
aging military officer he was. Gus had a large round face, lined
forehead, and a scalp that was bald except for a few whisps over the
ears and around the back. Tiny bubbles of sweat often oozed out his
pores. Gus always has a hanky handy.
His big face always wore a
broad grin - except when it didn’t. Like when he was worried or
fretting over something or someone. Gus was the Teddy Bear of the
resident bunch. He had a heart of gold and was truly concerned about
his patients,. He worried about them and cried over them when they hurt
or died. He cried on other occasions.
Dr. Wood was the oldest
resident in the program. He was in his late forties while the rest of
us were in our mid to late 20s. Gus had been practicing medicine here
and there within the military and government service for many years.
Gus had traveled the world far and wide looking for fulfillment and for
himself. He had drunk heavily at times along the way and “taken the
cure.” He had long abused his body, but at the time limited his vices
to chainsmoking and coffee guzzling. Altogether, the years told on him.
occasion, fellow residents would drop in on Gus when he was on call and
staying in the doctor’s quarters. If we found him stretched out with
his shoes off, we would be overwhelmed by the pungent and fetid aroma
emanating from his feet. No amount of foot powder or Odor Eaters could
ever neutralize the toxins and miasms which radiated from the soles of
his poor feet. Gus’s feet became the center of puns and jokes, smirks
and smiles. We all knew that we were in imminent olfactory danger when
we found Gus crashed in the call room. Regardless, we all thought Gus
was great and would never avoid a chance to spend a moment with him.
suffered not just over patients, but also over himself. Working in the
government service since medical school, Dr. Wood had neglected to take
a medical board exam and was therefore unlicensed to practice in any
state. He was not legitimized to do a civilian practice and he didn’t
plan to stay in the military forever.
So, Gus decided to go
back into formal training and brush up for medical boards. He joined us
as a second-year family practice resident. But, Wood was forever
carrying his perceived lack of knowledge and obvious lack of confidence
almost literally on his sleeve. I can see him now shuffling down the
hospital hallway, worrying about something and looking for a colleague
to lean on. He usually had his hands full of charts and papers. The
pockets of his long white coat overflowed with notebooks and cheat
sheets, pens and pencils, instruments and dosage calculators.
one time, I suggested that we sew a large pocket on the back of his
coat so that he might carry for “easy reference” a copy of Harrison’s
thousand-page, ten-pound Principles of Internal Medicine. The funny
thing was that if such a pocket had been feasible, Gus would have sewn
it himself. It might have eased a bit of his anxiety about not knowing
How much was enough? Gus didn’t know. He just had the
everpresent sense of inadequacy and continued to tell anyone who would
listen how much he didn’t know. Eventually, the Family Practice staff
heard his refrain one time too many. At the end of the year, they told
Gus, “We’ve decided you don’t know enough medicine, Dr. Wood, to be
advanced in the program. You also lack sufficient confidence in the
abilities you do have. You must repeat the second year of the
Gus’s two-year residency turned into a three-year
program. I suppose that he was ultimately relieved when the decision
was made. I assume that somehow the extra year made some difference.
For, Gus completed the program. The last I heard from him, he was
practicing at Fort Polk, Louisiana, and preparing anxiously to take the
medical licensing exam in Texas.
We all learn the hard way, at
least in some areas of our life. No one has a “free ride.” If Gus had
perceived the world as we did him, his battle would have been greatly
eased. He already had qualities of heart and compassion that some
physicians never get close to. Instead of carrying a medical textbook
on his back, he actually carried an invisible shining heart which
touched many people. That is a gift which a Frugal Physician gradually
develops and shares quite freely.
• Another physician named
George Hart (not related to the cardiologist) comes to mind. When I met
Dr. Hart, he was working as a psychiatrist at the Yellowstone Boys and
Girls Ranch west of Billings, MT. We sat across from each other for
lunch at a downtown cafe with a mutual friend in between. George’s
story - or parts of it - unfolded quickly. He was obviously a sensitive
and caring health professional. A soft-spoken, graying little man in
his early 60s, Hart had recently relocated from the East with his
As opposed to many psychiatrists who seem to hide
behind desks and beards and pipes, George was more than willing to
share his story and expose himself. The most poignant part of his life
up to the present time concerned an experiment in the 60s and 70s when
he purchased Great Duck Island (off the coast of Maine) to treat and
nurture psychotic patients without drugs. He apparently had some
successes, but he also took on a large burden which modern psychiatry
pretty much avoids by prescribing high powered drugs. That was the
tipping point. He helped people without drugs, but seemingly to his own
detriment. But then, the result followed his own lead.
midst of his storytelling, George recalled the beauty of the island and
the variety of animals which roamed its open spaces. Then, he got
absorbed in tell of a striking experience which occurred to him. He was
walking the land by himself in a meditative state, I suspect. He turned
a corner and encountered a lone deer. He stood within feet of it. Their
eyes met and he had some sort of ecstatic moment of other-worldly
communication. Hart began to cry in the midst of lunch. He practically
sobbed. Which was fine with me, but may have startled our mutual friend
who was a rather interiorized computer geek.
This moment was
quite obviously a profound healing experience for him, though he didn’t
seem to recognize it as such. I spent occasional moments with George in
coming weeks and months and, on occasion, sought to get him to revisit
the moment and draw out more meaning from it.
became more imperative when I met his new family and visited their
rural property. The Harts lived quite a few miles southwest towards Red
Lodge Mountain. George had a young wife, Martha, and two little
children, a boy and a girl. George seemed to have found family success
later in life as well as a retreat in the Montana countryside.
he was not occupied with his professional work at the Boys and Girls
Ranch, he could relax and enjoy his own ranch. The ranch had no cows or
pigs or sheep or even horses, but it did have dozens of DEER.
seemed to be a fantastic and poetic sequel to the Duck Island story.
Martha spoke of George going out to spend time with the deer in the
evening. Sometimes, he took a portable radio and tuned in classical
music for them.
There was a flip side to the idyllic picture,
though. Mrs. Hart told how difficult it was for George to do veterinary
tasks with the animals. Vaccination, tagging, de-horning and minor
surgeries on them created pains as well as chores for him. He seemed to
feel what his animals felt.
What was even more disturbing for
George was his intention to eventually slaughter the animals and sell
their meat to area restaurants. But, he didn’t seem to be consciously
aware of the conflict. He was an extraordinarily sensitive helping
person who worked with disturbed youth and cared for some of God’s
equally sensitive creatures. Deer are gentle, inquisitive, and acute
creatures. Just like George.
On more than one occasion, I tried
to suggest that there might be an alternative to slaughtering the
animals. “If these deer can nurture and heal you, maybe they can do the
same for young people like those who are struggling at the Boys and
The idea seemed to go nowhere. George thought his
ranch had to pay. Although I don’t think Geroge got very far along in
his plan to make his ranch venison available to local eateries. Life
has a way of getting in the way of plans.
One day out of the
blue, Bill, our mutual friend, told me, “George is in rehab at St.
Vincent’s Hospital.” I went up to see him. It was never quite clear
whether he had had a stroke or a heart attack. George was a
psychiatrist, not an internist. In any case, the episode gave him a
jolt and laid him up in the hospital for quite a period.
recovered and was able to return for a time to work at the Boys and
Girls Ranch. He later told me that it was in this time period that he
had an epiphany of sorts. It came to him that he had been dealing with
Attention Deficit Disorder his whole life without realizing it. And, he
needed to do something about it.
This psychiatrist, past 60
years of age, decided after all those years that he had his own mental
problem. George determined to do something about it. And, he did. He
convinced the family practitioner at the Ranch to prescribe Ritalin for
George was lost from sight for some time. I eventually
heard he was living at the Sage Apartments in Billings. I went for a
visit and found him spread around a dinky flat. His place was cluttered
and in disarray. His mattress was spread on the floor without frame or
He made no apologies but was glad for the visit. Then, he recited the update of his life since our last meeting.
Ritalin pushed George over the edge and into a psychotic breakdown. His
psychosis had played out in full view of his wife and children. After
Dr. Hart was sent as a patient to the State Hospital in Warm Springs,
his wife initiated divorce proceedings. He eventually was released and
returnedto a totally empty life.
I don’t know the final
chapters of George’s story. I do see that he died in 1997 (I last saw
him in 1993) in Butte as noted in a small obituary in a Harvard
At least two recurring thoughts come to my
mind when George Hart appears there. One concerns whether or not Dr.
Hart had Attention Deficit Disorder. That was his belief and caused him
to act accordingly at a critically passage. Then, Life really got his
Attention and he had the rest of his few years to consider the
More benevolently, I have always wondered whether
George had the capacity to learn the lesson of his meeting with the
deer on Duck Island. If there was a lession? Had he learned it, could
his life have ended differently?
The Deer definitely got his
attention in that poignant moment. Could he have retrieved the essence
behind it? Or, was he fated to end his days so sadly, from this
• One of the major lessons of medicine as well
as life is suggested in the Golden Rule which is part of practically
every religious tradition on Earth. “Do unto others.”
religion and spirituality aren’t part of the medical curriculum. Like
so many other key aspects of practically every person’s (and patient’s)
life. A Frugal Physician has so many of the deepest and most important
things to learn after s/he leaves the corridors of his/her medical
“Love your neighbor (patient), as your self.” But, how
often is the cart put before the horse? Physicians are constantly about
the work of helping, repairing, fixing others. Or, intending so.
can a physician truly love-help-aid-heal a patient until s/he has
developed the love of self? Self respect, esteem and love must arise
within a doctor, or s/he is just a technician. And, not necessarily a
We all must develop self love. So that we have some
real love to give away. Whether in the context of main street or
office, neighborhood or home. The physician is not alone in this
department of life. But, has a special calling to find the key to open
You wonder: “A doctor is supposed to keep a
distance from his patients. Be a professional and do his job. Now, he
is supposed to be spending more time loving him/her self and others
than addressing his/her occupation?”
Maybe the quickest way to
answer that one is to point out the obvious fact that many, many people
find their way to the doctor’s office because they are in need of
attention, reassurance, some form of love. The shortest route to
addressing those patients’ problems is to listen to them and to BE with
It seems more than likely that the vast majority of clinic
patients would do better with a listening ear than another
prescription. For many people, a trip to see the doctor at the clinic
is a way to get out of the house, have company and conversation, and to
experience more than the four walls and the television.
• A next
step in medical practice will then be such that patients become
brothers, family, parts of the self. Doctor and patient, patient and
doctor are really no different.
Standing face to face, the
patient should be a mirror for the physician. The patient is most truly
part of the physician’s larger self. He or she only appears to be
separate from the physician. Appearances can be deceiving, as we well
I assume that it is still common for patients to be
treated as less than - needy, sick, helpless, etc. Even distasteful
patients deserve more than being called names which place them
somewhere in Outer Darkness.
Health care providers must learn
to do unto others (their patients) as they would have done unto
themselves. “As ye do unto the least of these ...”
practice of medicine and the life of patients is often of one of “hurry
up and wait.” Patients can handle that. They have no choice. But,
physicians don’t manage well under that scheme of things. They like to
be in control and make things happen. “It needs to be done and as soon
Ah but, “Rome wasn’t built in a day,” and neither
was the patient’s body nor the practitioner’s. Patients need patience
and so do physicians.
Patience is a great virtue and worthy of
efforts to bring it into a physician’s armamentarium. “In patience,
possess ye your souls.”
Time is one of the great healers. One
that doctors use to their benefit more often than they realize. And,
might utilize even more consciously.
How long does it take to
make a human being or a body part the first time around? How long did
it take for the patient to get into his/her condition? Is it reasonable
to expect that illness and injury should be reversed more quickly than
it took for them to develop?
There is much for all of us to
experience and learn. Hopefully, we can better teach and learn more
gently from each other in the coming times.