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Patients Are People, Too
The Memoirs of Trester Smith Harris, M.D.

Chapter 13
Trends in Modern Medicine

In the late sixties and early seventies, the general practitioner almost became a thing of the past. Everyone wanted to be a specialist of some kind. The professors in medical schools went along with that idea, usually urging the students to take up a specialty of some kind. General practitioners were not allowed to do any of the things they used to do, like surgery, obstetrics and orthopedics. All they could do was to be a reference doctor for the various specialties, plus treat obesity, the common cold, and a few other conditions that required less knowledge. However, now the pendulum is swinging back, and some medical schools are developing Departments of Family Practice, or general practice departments under some other name.
 
The great difficulty is that very few doctors want to practice in rural areas. There are eleven counties in Texas without a doctor, and there are at least six medical schools in Texas. The same can be said of other states. Many counties, especially rural, are entirely without medical care. The tendency of young doctors is to go into the cities, where there is more money, as well as hospital facilities, and many doctors think there is better living for their families. The law does not recognize any difference in the quality of medical care now, whether in a city or a rural community, so some doctors feel there is more protection for them, in consultations, different opinions and in boosting their morale by other medical men. In fact, there is a tendency now to join a group, which certainly has its advantages.

As to malpractice, the country seems to have gone wild on it. There have been so many verdicts giving huge awards for malpractice, that a professional liability insurance premium has soared from around $800 to as much as $20,000 to $30,000 for orthopedists. It is around $3,000 to $5,000 for surgeons and is equally high for others. These amounts naturally have to be paid by the patient. Just recently, a huge judgment was awarded a patient who sustained bad results from an anesthetic. It is so worded that it can run as high as 25 million dollars, if the patient lives long enough.

The peculiar thing about medicines is that a person can be sensitive to some kinds of combinations of medicines with there being no way of the doctor knowing about it. It is just like an individual being sensitive, or allergic, to insect stings. Every year, more people in the United States die from bee stings than from rattlesnake bites, and many do not realize they have an allergy. Many people react to oral medication, as well as injected material. I have treated patients for allergy to penicillin. In fact, there have been many people react so violently to penicillin that they failed to recover. Can that always be the fault of the physician, when he is doing what he considers best for the individual under treatment?

There are many instances where certain medications react unfavorably. A very excellent preparation to relieve one of too much uric acid in the blood can cause a very unpleasant dermatitis. In fact, many of our very best drugs can cause considerable reactions of different kinds, but they are so valuable we cannot afford to discard them because of their rare reaction. Thus, I cannot see why the poor doctor can be blamed for every untoward bad effect of a prescription he gives. If a drug causes a reaction, discontinue its use and call the doctor.

In recent years there have been many new schools of medicine established, until now almost every state has at least one, and many states have five or six or more. We talk about there being a shortage of doctors, but in reality there is poor distribution instead. Many more doctors are being graduated now that ever before, but there are also many more applicants now than before. Of course, some applicants apply to more than one school, but so many are turned away, some find it necessary to go to medical school in a foreign country. Guadalajara and Mexico City are popular, as are schools in Spain, Belgium, and Italy. When we see that only 168 students out of 3200 applicants are accepted in a freshman class, we realize how many aspiring young people there are for medicine (that was at Baylor, 1973), and they are asking for work, for there is nothing easy about the study and practice of medicine.

There is a tendency now to stress graduate study in medicine more and more, fortunately. It began with the Academy of General Practice, which organized several years ego, and to which I belonged. It required a certain amount of graduate work in classes, and refresher courses, lectures and symposia. These were very excellent and allowed the general practitioner a chance to get some relief from his everyday activities and keep up with the progress in medicine at the same time. Loma Linda University, UCLA, and USC are giving some excellent courses and every physician should take some. It will become imperative soon that he do so. Many of the specialties, such as psychiatry, surgery, internal medicine and allergies are being taught. Many bulletins from excellent schools across the country are being issued regarding various courses. It will soon be necessary for all doctors to take refresher courses, as there is now some talk about the necessity of “keening up” in order to renew the medical license.

Another innovation is the Peer Review, especially in hospital practice. For years, most hospitals have watched the doctors in their work. In the case of surgery, the tissue report helps to keep the surgeon in line. If a fellow removes too many appendices or uteri, or any other organs that are normal, he is called on the carpet about it, but some hospitals have been rather lax about it and some surgeons have been able to get by with a great deal. Most hospitals are clamping down now and such surgeons are being restricted as to their surgical privileges.

The trend now-a-days is to join a group, instead of practicing medicine alone. And it has its advantages. A fellow has a chance to have some time off, knowing that a doctor in the group will answer his calls, deliver his babies or whatever comes up. Then, too, he can talk over his cases with someone else, there is always someone to refer his cases to if necessary, and there is a certain camaraderie in being associated with a group, which does not occur when one is alone (provided the wives of the group are compatible). The comparative figures show, also, that the average group practitioner has a larger income than the average lone practitioner, and the average doctor now likes his time off as well as his greater income, so group practice is for him. He has no bookkeeping to do, there is a receptionist for all, so his duty is to see the patients as they come in. Group practice really has many advantages.

Now in the days of Medicare and Medicaid, plus price freezes, it is more complicated by far to practice medicine. There is getting to be a certain amount of regimentation, as compared to a few years back. Now, doctors are told what they can charge, and it appears that soon we shall have some type of federally administered medical plan, so the poor Doc will not be able to work “for himself.” This, plus peer review, the increase in malpractice insurance, and the other instances of regimentation should make a young fellow think twice about going into the practice of medicine. Still, it is a marvelous calling, and even in spite of its bad features, I’d go into it again. There is a thrill in seeing someone improve under your care, especially if it has been a real ordeal. The look of gratitude given by a patient you have helped means it is worthwhile to carry on, in spite of the many obstacles that present themselves.

There are so many phases in the medical field. There is more and more research work being done, and some very valuable research, too. Cancers are being researched, and there is a feeling we are getting close to the cause of cancer. What a thrill it will be when the millions of dollars that are being spent will finally pay off and we have a definite answer. It will seem cheap to know how to prevent the dread disease, in spite of the expenditure, but the ones to thank are the individuals working on the project.

Likewise, a great deal of work is being done on arthritis, asthma, psoriasis, sickle-cell anemia, and many other conditions. When we think of the benefits of polio vaccine, measles and German measles, smallpox and, the other valuable contributions that have been made, some by pioneers and some by modern day scientists, we can be proud of our medicine men. There are other benefits to come, hypertension, heart disease, and kidney disease, to name a few. The small donation we make to various funds to fight diseases may seem not to accomplish much, but when they are put together and used for the many researches, it is amazing how much they can do. Who knows, some day there may be an effective remedy for the common cold. Then we can all rejoice!




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About the author
Trester Smith Harris, M.D. was born in Konawa, Oklahoma Territory, on October 17, 1903. His father was also a medical doctor. Dr. Harris was in private practice for many years in Los Angeles, then worked for a few years at a the California Rehabilitation Center in Norco, California. After retirement, he wrote these memoirs about 1973. He passed away on September 21, 1975.

Note: This memoir of my father’s experiences and opinions is not intended to constitute medical advice. If you have medical questions, consult qualified medical authorities.


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