Putting The Puzzle Back Together
Daily Observer
S.Q.
Lapius was dressed in bathrobe and green
eye-shade. He was hunched over his desk
poring over the array of papers, scribbling notes. From time to time he would open bound issues
of medical journals and leaf through the pages till he found the reference he
was looking for, then jot some more notes.
As if this weren’t enough he would pad over to the bookshelves in his
sheepskin bottles and pluck another volume to search an index. This was a ritual that occupied him at least
two evenings of every week.
“How
many publications do you have now, Simon?” I asked, when he paused for a break.
“I
haven’t counted them Harry, forty or fifty.”
“Not
bad for a man in practice, considering that you have to borrow the time from your
spare moments.”
“Of
course you realize, Harry,” Lapius said, “that now I
write mostly case reports. In my younger
days when I was doing clinical research the articles I wrote had more
substance. Of course that was my job
then so I could attend to it during working hours. But the papers were more complex, of
course. I like to think they comprised a
contribution to the medical literature.”
Lapius had great reverence for the medical literature. “It is our thread to the past,” he would say,
“our link to our medical forefathers.
The medical literature expresses the tradition of medicine, and reflects
the increasing advance of science into the art of medicine. It is quite fascinating.”
“And
hard work as well.”
“Of
course, but what a learning process.
There’s nothing to equal it. The
exhilaration when the pieces of a puzzling concept fall into line and you find
the words to express it. Really, you
should write more than you do, Harry.”
“I
haven’t the time,” I said.
“Ridiculous,
my boy. Of course you do. That’s a lame excuse.”
“It
might have been a few years ago, Simon,” I said, “but if you would take your
nose out of the books for a few days you would find out that you are supposed
to prove that you have several hundred hours of approved medical education
every so often, or else you are threatened with loss of licensure, or a
recertification examination.”
“You
are spoofing,” Lapius said, as he turned back to his
books.
“Not
a spoof, Simon. A fact. If you don’t demonstrate to the satisfaction of
the examiners that you have attended the required number of approved
conferences your career is at stake.”
“No! Where did you read that nonsense?”
“No
nonsense – well, I agree it is nonsense, Simon,” I explained, unable to believe
that this crucial demand on the doctors’ time had escaped Lapius,
“but nonsense or not, it is a fact.”
Lapius stared at me his eyes, peering over his glasses
perched on his nose, reflecting the green of his eyeshade. “What imbecile concocted that business?” he
inquired.
“The
imbeciles in the legislatures of most of the states of the union,” I
answered. “It may even come to pass that
unless a doctor is deemed qualified according to the latest educational
demands, that Medicare will refuse to authorize payment to him.”
“What
pompous presumption is that. And who
qualifies the legislators to make such rules.
Who is to tell me what is and what is not educational? Certainly I have sat through some of the
dullest lectures by ill-informed dolts that the state society sends around to
meetings to lecture on specialized subjects.
Some of them are preposterous, ill-prepared, projecting illegible
lantern-slides to illustrate subject matter that they soon demonstrate is
foreign to them. Is that supposed to be
the education we are required to feed on?
And how many credits will I get for all the study that goes into writing
one of my papers? How many credits will
I get for scanning the medical journals at my bedside, for the hours I listen
to medical tapes, for the forty years devoted to hospital rounds, emergency
care, office practice, each moment of which represented a new learning
experience?”
“Well,
there is one way to get out of it. You
can join a medical faculty. The
assumption is that professors are keeping up with the new things, so they are
exempt from recertification.”
“Ha,
ha, that’s a laugh. Professors these
days are young fellows, addicted to the new.
I’ve been around too long to be taken in by that. Sure they are bright, but also sequestered, hidden
from the main-stream of human problems.
If
my years in medicine have taught me anything, Harry, it is that although the
causes and treatment for disease keeps changing, the disease itself remains the
same. Why, when I left the faculty it
took me several years to get my feet on the ground, to learn to stop treating
disease and to start treating people. I
don’t see why faculty members should be a protected species, unless of course,
it is they who will make up the tests that will be used to recertify us poor
commoners.”
“That’s
the idea,” I told him.
“Well,
then more is the pity then, Harry. The
more things change, the more they are the same.
Our leaders will pass on our qualifications, but who then will pass on
the qualifications of our leaders?
Anyway, it’s time for me to get back to work, so if you will excuse
me-.”
“So
you won’t enter into the spirit of the thing?”
“Presumptuous
‘gobbledegook!’
I certainly won’t give up precious hours to an educational program
prescribed for me by someone else. I
will just continue to do what I and generations before me have always
done. Attend to the business of
medicine; which means attending to my patients, puzzling out conflicts in
diagnostic facts, reading the medical literature, and reporting what I believe
will be helpful to others.”
Lapius turned his back to ma and resumed his studies. The dialog was ended.