Reflections on Medicine - January 2008
By Mavis P. Kelsey Sr., MD
I intended to become a country town doctor like my grandfather. However, my training led me into internal medicine. My experience at Scott &White and the Mayo Clinic led me to believe the clinic practice would expand rapidly in America. This inspired me to leave the Mayo Clinic, return to Texas in 1949, and organize a general clinic. I was fortunate to have several well-trained physicians join me as partners.
Against advice, we started out in the highly competitive, rapidly growing Texas Medical Center, but the medical center grew and we grew with it. We pioneered branch offices, income sharing, contract practice (including NASA nationwide), pre-pay care, on-site health delivery to companies, hospitalists, medical assistants, and many other new services. Today, 58 years after we started the clinic, there are 20 branches and 300 physicians in the Kelsey Seybold Clinic. The clinic is now a unit of the St. Luke's Episcopal Hospital System, but the partnership still runs the clinic.
I can only emphasize what everyone already knows. I learned early that a doctor has to take very good care of his patients if he intends to build a practice. Fortunately, I was taught in medical school and residency the importance of thorough medical knowledge, doing a thorough examination and follow-up, being compassionate, and putting the patient's welfare first.
During the past 70 years, many things have worked out well for medicine, mainly the result of the incredible explosion of knowledge and technology. Man's life expectancy has increased 30 years since I graduated in medicine. But much has not gone well.
In spite of delivering improved care, doctors' prestige has declined. Ironically, there is more good medicine available today than the average person or employer can afford to finance. We didn't miss many diagnoses when we could spend an hour doing a careful history and physical examination and order any tests we thought might be helpful in diagnosis. There also were tests we thought should be done routinely during an annual examination, including a blood count, sedimentation rate, urinalysis, and chest x-ray. This type of examination is rarely possible today.
Even as I prepare these notes, I learn of a former patient who received a skimpy 15-minute examination, no laboratory or x-ray examinations, and turned up a month later to have a carcinoma in the lungs and other widespread metastasis. It happens all the time.
Medicine has become commercialized. There is a disparity in income; more than half of those in the profession are underpaid, while a significant number are making inconceivable large sums. There is waste and overpricing. Our government has not been able to mandate any form of compulsory health insurance. We are bogged down with bureaucracy. Newly threatening epidemics, AIDS, and drug addiction plague us.
What is the outcome? We are now in an economic revolution. We are in a world war against terrorism fueled by a radical religion. Political bickering divides the country. Things will get worse before we wake up. We must get better or we will become a second-rate nation, and medicine will be only one of the victims.
Still, I am more optimistic about medicine than about most other careers. The world cannot do without doctors. In spite of all its problems, medicine offers a life of service to mankind and the challenge to take a role in getting things right. The opportunities are great because we have a lot of things to correct. Advances in the diagnosis, treatment, and prevention of disease are expanding rapidly and offer even greater opportunities for a career in medicine. Now, well-trained doctors can always start with a paying job. In 1949, we opened an office with no patients and no income. We sat on our hands for a long time before we made a living, but we finally succeeded. You just have to try.
Editor's Note: Dr. Kelsey is retired and lives in Houston. He is a graduate of Texas A&M and The University of Texas Medical Branch (UTMB) at Galveston. He interned at Bellevue Hospital in New York, spent a year as a pathology instructor at UTMB, and completed residencies in internal medicine at Scott & White and the Mayo Clinic. He served in the U.S. Air Corps from 1941 to 1945 and was editor of the Air Force medical journal. He attained the rank of lieutenant colonel and received the Legion of Merit.
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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