Reflections on Medicine - December 2007
By Masashi Kawasaki, MD
Woven through my journey as a medical doctor, my Japanese heritage plays a significant role. My father told me a story once of a warrior during a civil war in early Japan. Despite seven defeats, the warrior continued. Finally, he was victorious in his eighth battle.
I was born in Vancouver, British Columbia. Much like the Japanese Americans in the United States during World War II, Japanese Canadians were forced from their west coast homes into internment camps in the scenic, but hostile, environment of the Rocky Mountains in Eastern British Columbia. Although some families were separated during the forced internment, I am thankful that except for a brief time, both of our parents were with me, my two sisters, and younger brother throughout those four years.
Frequently, I contemplate the possible course of my life if Catholic sisters had not come into the camp to educate interned Japanese children. The Canadian government did not assume that responsibility. After World War II, Japanese-Canadians were released from internment camps. Canadian law prevented their return to the west coast of Canada.
Our family settled in Windsor, Ontario, just across the river from Detroit. My siblings and I were the first Japanese to enroll in the public schools.
Despite meager finances, my parents insisted I attend college. I enrolled in the University of Western Ontario (UWO) in London, Ontario. The third year of college, biology professor Helen Battle, PhD, insisted I apply to UWO medical school. Acceptance to UWO Medical School made me not only the first Japanese (and Asian), but also the first minority to enroll. The need for finances caused me to attempt part-time employment while a medical student. The stressful schedule led to a serious illness that forced me to drop out early in my freshman year of medical school. After two years of medical care and convalescence, an understanding dean, James Bertham Collip, PhD (one of the team of four to discover insulin), permitted me to return to medical school.
After an internship at Victoria Hospital in London, Ontario, I was appointed to an otolaryngology residency program at Washington University-Barnes Hospital in St. Louis. Even though I was a Canadian citizen, my Japanese heritage presented a problem when I applied for a U.S. visa.
At the conclusion of residency, the National Institutes of Health granted me a fellowship in research at the Department of Otolaryngology at Washington University. Later, I became assistant professor. For more than a decade, I struggled with legal hurdles posed by the U.S. Immigration and Naturalization Service before the long-term visa problem was solved.
In November 1968, I left St. Louis and academia to join the Dallas Medical and Surgical Clinic. The next year I became the first Japanese (and Asian) to obtain a permanent medical staff appointment at Baylor University Medical Center in Dallas. Several years later, I established a solo otorhinolaryngology practice and also became a naturalized U.S. citizen. Throughout my practice, I was appointed to the medical staffs at three other hospitals and helped train residents at The University of Texas Southwestern Medical Center. I also served as honorary consul general of Japan.
Though time gives us innovations and advancements in medicine, there remains a gap between academia (the Gown ) and the private practitioner (the Town). I realized this when I was on the Gown side at Washington University Medical School and became more aware of it while in the Town side in Dallas.
Even in retirement, when I mentor otorhinolaryngology residents at UT Southwestern, I sense the dichotomy still exists. The two groups can become interdependent if the Town develops proactively while the Gown assumes a less haute persona - more like a Cap and Gown relationship. Both are necessary for a superior health care delivery system. Perhaps a solution to the distancin g will occur if there is a crisis - a time when dire necessity causes the Cap and Gown to merge.
The creeping takeover of medical care by the insurance industry causes multiple problems for medical doctors and patients. The political arms of the American Medical Association and other professional medical organizations haven't derailed the encroachment. The powers of insurance and pharmaceutical companies are too powerful to overcome.
I fear universal health care will become a reality, presented as the solution to increase the quantity of health care in this county. If so, I fear the long-term effect on the quality of health care delivery. Doctors' enthusiasm for patient care and fulfillment of their emotional needs will fall victim when this occurs.
We "seasoned senior doctors" tend to offer advice to those entering the profession when it is not requested. Due to recent reported experiences of several friends with medical office personnel, I venture a suggestion. I think changes caused by the infringement of insurance companies promote a setting for insensitivity and irresponsibility in patient care. I hope doctors will not demonstrate this, but their office personnel could, if they become complacent in the absence of supervision.
Office procedures that focus on attentive patient care are of prime importance. Without a visible and capable office manager, personnel can become lax in listening to patients or fail to complete necessary follow-up proceedings and even present an uncaring attitude. Office administration needs to be included in the medical school curricula, and doctors should continually update the human resources and public relations aspects of their medical practice.
I consider it a privilege to be a medical doctor. Even though I experienced financial, physical, mental, and bureaucratic struggles to obtain a medical education and license, I would walk this path again. Medicine is a noble and honorable profession.
Dr. Kawasaki lives in Dallas.
Editor's Note: This is the latest in a continuing series of essays and reflections on medicine by members of the TMA 50-Year Club.
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