A Frugal Physician Prescribes
Common Sense and Enthusiasm
few generations ago, going into medicine, nursing and ancillary
professions often required many years of real sacrifice. These were
truly service careers. Physicians were paid sparingly if at all in
training and earned little in the first years of practice. Medical men
had to fight for specialized training, take what they could get, and
work like the dickens. They were sure to be in debt for many years
while getting their practices started and established. Big houses and
long vacations often didn’t occur until late in careers. Physicians may
not have been necessarily frugal in those days, but they certainly
didn’t get well-heeled in a hurry.
Financial rewards have
changed dramatically from era to era. Sacrifice is hardly an apt word
in recent times. Physicians are handsomely paid from the get-go.
Salaries start in the six figures range. Registered nurses and even
CNAs garner substantial wages.
In the “olden days,” hospital
workers barely made ends meet. I remember my maiden Aunt Elizabeth, a
registered nurse for fifty years, bemoaning the long hours and low pay
she accepted while working on hospital wards. I also recall her pulling
out one of the many scraps which she kept in one drawer or another. A
little article detailed the duties of a floor nurse in an era just
before hers. “The Frugal Nurse” might have been a fitting title for
that period. Among other parsimonious tasks, the nurse in training was
directed to conserve her one pencil until it was little more than a
Service like frugality has gone by the wayside to a large
degree in medical practice and many other areas of daily life.
(Consider for a moment the United States Postal Service. The writer is
of the opinion that Americans got more SERVICE when it was the Post
Office than since it became the USPS.) These days, it is the
physician’s schedule, plan and protocol that are most important. The
patients’ needs too frequently come second or farther down the order.
The reader undoubtedly has stories which which support this thought.
service puts the customer-patient first when at all possible. It also
points to the importance of care and compassion in medical practice.
How often have you felt that you were really the most important person
in your physician’s life - if only for a moment? How do you rate your
physician’s bedside manner? Is s/he really with you - present - when
entering the room? Or, just running from one obligation to another?
doesn’t cost a penny, but it can be invaluable. It can be as simple as
taking one extra moment to show care and concern. I saw this
demonstrated ONCE in my third year of medical school while I was on Dr.
Red Duke’s Surgery Service. Duke was a hard-charging, no-nonsense
cowboy who was also Director of the Hermann Hospital Emergency Center
at the time. He eventually became famous by doing a syndicated Health
Reports show and having his life played as Buck James by Dennis Weaver on television.
wiry, redheaded, bespectacled Duke would careen through Hermann
Hospital corridors with our entourage keeping close pace behind him. He
was quick to make decisions and move on to the next task. But . . .
he wasn’t shy about spending time and getting close to patients, an
unusual occurrence it seemed, especially for a surgeon. I remember our
group standing behind him during morning rounds in a man’s hospital
room as Duke traded questions and answers back and forth with his
patient. Something caught his attention and caused him to move closer
to the man’s bed. Then, he sat down on the edge. He motioned for us to
leave the room as I heard him say to our patient, “Have you got time to
“Have you got time to talk?” Wow! Consider the implications of that simple remark to a patient.
is so important in the present age that it is hard to imagine life
without mouths flapping and words flowing from them. Yet, there must be
times when we all wonder if our wind is worth the effort, especially
when we remember it takes two to have a conversation.
practitioners use clever and honed questioning in their desire to
quickly get to “the bottom of the case.” However, these rote litanies
often elicit flat, dull or meager responses. This causes physicians to
find what they are looking for. “A person hears only what he
understands.” (Goethe) But, will the result be good for their
customers: patients with unique and personal problems?
medical student, I was at times intimidated by surgeons. They were
larger than life in some respects. And, they seemed to like it that
way. “We’re saving lives every day.” Especially trauma surgeons, like
Blood and guts never suited me much, even though I
entered medical school thinking I wanted to become an emergency room
physician. Having spent a tour as corpsman in Vietnam and worked in
three other ERs before med school, I had been excited by the speed and
drama of the Emergency Room. Patching people up and putting them back
together seemed a magical formula. But, many things are not just as
they appear to be.
Neither was Dr. Duke. He had that brash “cut
him open and stop the bleeding” part to him. But, he also was a wise
ol’ country boy. I suspect he had more than a little common sense and
compassion in him. He was an enthusiastic cheerleader for his brand of
medicine, for his trauma center, and for the medical school. He no
doubt cheered for patients, too.
Enough to take time out from
playing Chief of the Surgical Team to close the door and sit and
converse with another soul.” I wish I could have been a fly on the wall
of that hospital room,” as my mother might have said. I might have
learned even more.
Of course, Duke might have just wanted to
have a man-to-man conversation about the Texas Longhorn’s coming
season. But, I have to believe he had more than football on his mind.
comes in many forms and I am quite sure that Red Duke knew it. If a man
needed the knife, so be it. If he needed some one to talk to and hear
“the rest of the story,” Dr. Duke could surely handle that.
episode stuck in my mind, like many others. I carried it with me until
many years later after I had “taken down my shingle.” I was sitting
close to another man’s bedside in a hospital room in Montana. I had
shied away from medicine and hospitals for quite a few years when I
“fell into” a job in the education department of Billings Deaconess
Hospital. Drawing on my medical experience and computer interests, I
did program development for hospital health and safety training.
that time, I got it into my head to do some volunteer work on the
wards. When asked how I would like to help, I said, “I would like to
read to patients.”
For other volunteers that usually meant
newspapers, but I wanted to read books. I did so with just three of
four patients. But, one patient made it all worth the while and kept me
reading for months.
Mr. Les Trafton had been in the hospital for
many weeks by the time I arrived on the scene. A retirement-age man,
Les had lung cancer which necessitated removal of one lung. He arrested
on the table and a series of sad complications ensued.
had a tracheotomy, could not talk, but was clearly pleased to have new
and regular company. His wife, Max, and sister-in-law were often in
attendance when I appeared several times a week to read Louis L’Amour
books to Les. We read a number of westerns, then a modern novel, Last
of the Breed. I eventually got my fill of western novels and the
Sackett family by the time months later when Les was finally
transferred for a few weeks to his hometown hospital in Miles City.
the way, I became part of the family, so to speak. I’m sure Les
appreciated the male company, but the two ladies did so as well. In
future months, I made two visits to the Traftons at their home.
Hospitality replaced hospital time.
I could only take so much
Louis L’Amour and got agreement for me to read another classic western,
Shane. Just before the Traftons left town, Max and I went out and
rented the video. The three of us watched the movie in one sitting and
drew even closer together.
I can’t help recalling moments when
Trafton’s thoracic surgeon “peeked” his head into the room or stood at
the foot of the bed and tried to carry on a conversation. In later
weeks, Les’s tracheotomy had been repaired and he was able to speak.
Still, the give and take between physician and patient seemed miniscule
and distant. I wonder if Les’s surgeon ever sat at the edge of his bed
and had a heart-to-heart talk with him. I wonder if he ever did that
with any patient, if he ever read a western to anybody.
people wish that old-time country doctors were still in business. The
search may not be in vain when there are old-time country patients on
the lookout for that supposedly dying breed.
Red Duke took time to sit on the edge of his patient’s bed to visit
with him. To be a friend as well as a physician. Both undoubtedly
gained something from the spontaneous exchange. There seems to be many
reasons to believe that more physicians, frugal and otherwise, can do
much the same.Home Page