Reflections on Medicine - October 2008
Tex Med . 2008;104(10):13.
By Herbert L. Fred, MD, MACP
All things are changed, and we change with them.
― Lothair I, Holy Roman Emperor, circa 840 AD
During my career as a full-time medical educator, I have witnessed many changes in our profession, especially the way we teach students, interns, and residents. Please join me as I remember things from almost 60 years ago:
- House officers had no formal contracts, and unless they demonstrated unflagging commitment, they were fired -- sometimes on the spot and without warning.
- Except for two weeks of vacation, interns worked every day and at least every other night, all year long.
- Compensation for interns ranged from room and board only to $50 a month.
- Medical students, interns, or both, did all of the initial and follow-up blood counts, urinalyses, stool guaiac tests, sputum stains, and electrocardiograms.
- Interns on call drew morning blood samples from all the ward patients -- usually about 30, sometimes more.
- Serum potassium levels and blood gas determinations were available only from research laboratories, and only once or twice a week.
- Syringes were ill-fitting, made of glass, and easily broken.
- Needles were not disposable and were frustratingly blunt.
- Intensive care and coronary care units were nonexistent, and life-support equipment was crude.
- Only house officers wrote orders for the patient.
- The referring physician and the consultant met at the bedside to examine the patient together.
- Monitoring seriously ill patients required use of one's mind and five sensory faculties, coupled with frequent trips to the bedside and long bedside vigils.
- Pacemakers were bigger than car batteries, housed next to the patient's bed, and with each electrical impulse, the patient's entire body jumped.
- Intravenous fluids were made in the hospital and administered through reusable rubber tubing.
- Southey tubes were inserted subcutaneously to relieve intractable peripheral edema.
- Measuring the venous pressure in the antecubital space and determining the circulation time were standard procedures for all cardiac inpatients.
- Rheumatic heart disease was as common as coronary artery disease.
- Syphilitic aneurysm of the thoracic aorta was a leading cause of superior vena cava syndrome.
- Poliomyelitis was rampant, and patients in iron lungs occupied much of the house officer's time.
- Weekly grand rounds consisted of two or three case presentations in which the patients were present for everyone to see and for a privileged few to question and examine.
- Autopsies were an indispensable teaching tool, required for hospital accreditation.
- Radiologists wore red goggles.
- House calls were still part of some practitioner's daily routine.
- Health insurance was affordable and easy to get.
- Medical malpractice suits were virtually unheard of.
- An ECHO was something you might hear after shouting in a canyon, MRI referred to moderate renal insufficiency, and a CAT scan meant catching a glimpse of your feline pet.
Finally, I remember when medicine was a highly respected calling, the noblest of professions.
Dr. Fred is a professor in the Department of Internal Medicine at The University of Texas Health Science Center at Houston.
Editor's Note: This is the latest in a series of essays by members of the TMA 50-Year Club .
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