Musings of an elderly 20th century doctor 
I was smug, happy and secure in my early days of practicing Internal Medicine. I was Board certified and belonged to the organizations of my profession. I could keep up reasonably well by reading no more than four of the leading journals of the day. The articles were given reality and utility by my attending and participating in local, regional and national conferences.
I took care of my patients and they took care of me and we didn’t know any better than to be happy with the arrangement. I agonized over my errors and mistakes, but took some solace in being forgiven by my patients as being only human. I had no illusions about being an expert authority, knowing all the currently accepted information that changed slowly although continuously about a particular organ system or disease.
Instead I knew much less about a much broader array of medical science punctuated by patients and their problems. I felt reasonably competent with no need for posturing arrogance in caring for my patients and providing consults (Internal Medicine was a specialty then) for general practitioners as they were known at the time. Mostly I recommended discontinuing unnecessary medicines and made a good living out of it.
I reassured my one patient whom I finally “recognized” as having polycythemia rubra vera that he need not worry.. It wasn’t life threatening and all he needed to do at most was to have some blood drawn and discarded from time to time if his hematocrit got too high, say 50% or so, and to relax and just be thankful it wasn’t leukemia, I’ve often wondered if he lived a long and happy life without stroke or progression as so many do. I truly hope so. My patients and I were friends with mutual respect and needful dependence on each other.
Down through the years the world of medicine has changed exponentially. Basic supporting sciences, therapeutics, methods of delivering services, narrowing of specialties with ever increasing division into subspecialties, partnering with physicists, chemists, geneticists. engineers and other experts in their fields is far more common and complex nowadays. Institutions, costs and methods of payment have changed dramatically and not always for the better. Elaborate “hardware” and amazing “machinery” found in even moderate sized hospitals and research institutions are now considered part of the usual equipment. Equally new and different from my day is the “software” of medicine; how doctors and their colleagues and assistants keep up, learn from, collaborate with and teach each other. Much of this is owing to the proliferation of in depth information concerned with the art and science of medicine and the practical applications in its practice.
This knowledge has become easily available to an informed laity, but availability doesn’t always equate with either necessity nor utility. Organ and disease specific advocacy groups, some supported by medical institutions and pharmaceutical companies, are becoming common; some for profit or barely not for profit. Others are more altruistic and with less generous salaries, expense accounts and operating expenses.
The dissemination of MPN information and the giving and receiving of general medical advice by an informed laity is a valuable part of Medicine’s growth and maturity.The accumulation of knowledge about their disease is important for all patients and information and advice shared widely and unrestricted by MPN patients and their caretakers is vital. This valuable, information must be accurate and reliable.
Suggestions of a general nature by someone “not a doctor” wishing to help individuals as well as other interested readers to learn and make personal decisions for general use are helpful, as opposed to advising a specific patient re specific management of his medical problems. Giving such advice is rather like practicing medicine and might be counter productive at a minimum.
Editorials, essays, position papers and the like are valuable for “spreading the word” about a poorly recognized disease and for educating fellow patients and “the usual suspects”. Produced and distributed widely by competent well read laymen, especially (and particularly) if they have the added experience, understanding and perspective that comes with having the disease will do much good in educating patients and calling public attention to a little known neoplasm., Some say cancer!
When lay experts edit and offer opinionated personal versions of medical information gleaned from sources such as the internet and advocacy lists the risk of spreading knowledge without wisdom arises. Editing, paraphrasing, speculating, etc. with reference to the opinions, findings and conclusions of recognized and accepted medical professionals are interesting and educational and well may lead toward new truths or at least toward eliminating old errors.
I sincerely hope not to have dimmed anyone’s holiday cheer with this verbose chatter (if I may use the word). :) Best, Arch
Take me back to the Contents
© Dr. Arch M. and MPNforum.com, 2011. Unauthorized use and/or duplication of this material without express and written permission from this blog’s author and/or owner is strictly prohibited. Excerpts and links may be used, provided that full and clear credit is given to Dr. Arch M. and MPNforum.com with appropriate and specific direction to the original content.
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Comments on: "Arch’s Corner – January" (2)
Ah, for the good old days with the family doctor’s. I remember that my doctor did eveything from taking off bumps on the skin, stitches, etc. I also remember that he kept thermometers on his desk which were sanitized in alcohol. He knew and cared about the whole family, made house calls, was on time with his appointments and would also except phone calls. I sure miss those days.
Nice column sir!