GETTING DOCTORED: CRITICAL REFLECTIONS ON BECOMfNG A PHYSICIAN
BY MARTIN SHAPIRO, M.D, NEW SOCIETY PUBLISHERS; 1987,
Medical school, internship, and residency training are full of experiences of passionate intensity. The plethora of books and movies that describe medical training are based on the theme, "How I survived my journey through Hell." The author, a lonely and compassionate hero on a mission to help humanity, encounters insensitive and cruel professors who take time from their quest for power to degrade and humiliate him; backstabbing classmates whose disdain for patients is outstripped only by their lust for making money; and an impersonal health care delivery system ruled by technology without regard for human needs. "And so, dear reader, the author concludes, "disillusioned and downtrodden by my experiences, I gave up the dream of becoming the compleat physician, and turned instead to (writing, public health, consumer advocacy, conflict resolution, the Carmelite order, the Hastings Institute for Medical Ethics, pontification—choose one of the above)."
Martin Shapiro studied hard in high school
in Winnipeg, went to medical school at McGill, became disillusioned, and
chose options 1 and 2, above. "Criticism is an act of love," begins Getting Doctored. The author has much love to offer. In just 200 pages, he offers a remarkably comprehensive perspective on the failings in our system of training physicians. The competition for advancement is marked by games and rituals: "I know more than you do," " know something you don't know," "I can study longer than you can and move to the front of the class." Mastery of enormous amounts of useless data is accomplished through obscene and misogynistic mnemonics: "Lovely French Tart Sitting Naked in Anticipation" (the first letter af each word stands far a branch of the external carotid artery), or "Thick-Thighed Ladies Live in Place Ville-Marie" (the eight essential amino acids). I recall from my own days in Chicago, "Oh, Oh, Oh, To Touch And Feel A Girl's Vagina! Ah, Heaven!" (the twelve cranial nerves). A few anecdotes bring a human touch to this pessimistic treatise, but they are too brief and infrequent. A glossary of medical abbreviations serves as a
guide to the consumer for the demystification of the doctor's alphabet soup (R/O MI, DOE, SOBOE) that serves to alienate and
elevate the physician from his patient. The book's jacket contains a quote from the Journal of the Canadian Medical Association, exhorting "everyone concerned with medical education, whether student, graduate or teacher "to read this witty and thoughtful account about becoming a doctor." Anyone who does will consider selling used cars as a more noble profession." And the patients...should this book fall into their hands, we doctors will be reduced to driving around in used cars.
Perri Klass writes beautifully. It's in her blood--her father is a writer, she wrote the "Hers" column in The New York Times, and was a contributor to Mademoiselle. (Doesn't everyone who reads TFR read Mademoiselle?) Her book, A Not Entirely Benign Procedure, is a joy to read, full of life and humanity. It is a highly personal account of her experiences at Harvard Medical School, The anecdotrs are complete and perfect vignettes of suffering, pain, small triumphs, petty jealousies, and deep empathy. Her portrayal of the rigors and competition of "roundsmanship" leaves us with sympathy for the players forced to play the games described by Dr. Shapiro. Klass and her classmates struggle to find meaning and compassion, while they fend off the lions in the arena. In the midst of her training, she has a baby, and tries to wear the new-found gowns of medicine and maternity, and still recognize herself in the mirror. Dr. Klass offers the promise and hope that the advent af women to medicine will bring about a return of the caring, compassion and mutual respect that once marked the patient-doctor relationship,
Something, however, is missing from these books—fun. I had fun in medical school. I learned to play the accordion. I traveled. I laughed a lot. I made good friends. I loved my wife. I played poker. And I discovered opera. Here is how that happened.
Dr. Sheinin was The Chicago Medical School. He had rescued it from the ranks of the "diploma mills“ and had turned it into a first-rate institution of teaching and research. As dean and president, he governed faculty, students, and board with an iron fist. We all marvelled at how a wiry man of 5'3" could inspire dread not only in first-year medical students, but in the giants of medicine that taught them, as well. Yet, he knew each student by name, his strengths and weaknesses (and how much his father was gaod for towards the school's endowment fund). His domination of the school was absolute, as he reminded us at our first meeting with him in the amphitheatre. "Boyiss," he roared at us in his thick Russian-Jewish accent, "Who da Hell da you tink climbed up on a ledder and painted da kadushasuss (cf. caducei) and lemps af knowledge det you see around da top of da room? Dat's right, me! And don't you forget it!"
During my second year, the board of directors decided that the school needed new blood and a new image. Dr. Sheinin continued as president, but a new dean, Dr. Daniel S. Kushner, was recruited from Yale. His crew cut, Harris tweeds, button-down collars and repp ties, along with his polished speech, unmarred by any trace of an accent, would bring some badly needed ivy to the bricks of our building. Dr. Sheinin did not seem entiraly pleased. He roamed the corridors, as was his habit, asking students, "So, nu? How do you like my Danny-boy?"
The following year, five freshmen were apprehended with a stolen biochemistry examination. After purloining the exam, one of them was foolish and lazy enough to bring it to a biochemistry instructor at a neighboring medical school for help with the answers. The instructor called the biochemistry professor at my school, who reported the hapless student to the new dean. Dr. Kushner summoned the student to his office, and promised to go easy with everyone involved if the student would confess and reveal the names of all the perpetrators. When all were assembled in his office, the dean informed them that they were all expelled.
The students petitioned for assistance from the student council, and, as president of that body, I was delegated to intervene on their behalf. When I discussed the matter with Dr.Kushner, he reminded me of the grave responsibilities that awaited a physician, and of the need for scrupulous honesty and ethical practice. When I asked if he had offered immunity in exchange for a full confession, he responded that extraordinary diligence was necessary in order to preserve the sanctity of our profession.
After deliberations of the student council,
it was decided that I should bring the matter to Dr. Sheinin. He was only
too pleased to listen. I had never seen him so animated. As I sat trembling
in a straight-backed chair in the center of his cavernous office, he circled
me wildly like a lean and hungry wolf, railing at the cruelty of men. Obscenities
poured from his mouth as he decried the treachery of administrators, the
corruption of bureaucracies. His tirade ended with, "It voss like Tosca,
Michael, like Tosca!. He told dem he'd use phony bullets, but he
used real bullets!" I had no idea what he was talking about, and wanted
only to escape from his office before the meltdown took place, When I arrived
home, I told my wife what had happened, and
asked her what Tosca meant. "I think it's an opera," she replied.
I went to the library and took out the record of Tosca, in order to read the story, so as to understand Dr. Sheinin's allusion. I had been to the opera once, a five-hour performance of Die Meistersinger, heard from the family circle (the cheap seats of the old Met)—hardly fare to whet the appetite of a neophyte. Casually, I put the record of Tosca on the turntable. Out came Puccini, through the heavenly throats of Callas, Di Stefano, and Tozzi, and it was gorgeous.
At my graduation ceremony the rollowing year,
I told Dr. Sheinin that hs had created an opera fanatic. Dr. Sheinin
presided at the ceremonies alone, for after the students had been reinstated, Dr. Kushner moved on to cleaner pastures.