Things, they are a-changin’

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Medicine during my career (Part 1)

By Dr. T. Jock Murray

For The Advocate

The Good (?) Old Days

When I entered medical school in 1958, it seemed an exciting time to become a physician. There were new vaccines, dramatic surgeries, psychiatric drugs, early pacemakers, and the first kidney transplants. The concept of a randomized clinical trial was being applied to show if a treatment really worked. Watson and Crick cracked the DNA code. Some of these advances were in early stages but we could see the future. In the post WWII era there was a sense of hope and a belief that science and medicine would bring great changes.

It was not difficult getting into medical school. They were looking for qualified candidates and 30 percent of my class were Americans, many of them Jews who had trouble getting into American schools. There was one woman. My medical education was standard for the time, a pattern of two years of mostly lectures, followed by two years of increasing clinical contact with patients, followed by a year of a gruelling rotating internship, which earned me $100 a month. Janet and I, with two small children, paid rent of $95 a month.

Looking back on my training, it was a good education but lacked many features in current medical education. Our teachers wanted us to be well rounded, ethical and professional physicians, but they took a lot of things for granted. We did not have teaching on medical ethics, medical economics, professionalism, or sexuality. There was no communication skills training. We were expected to pick up clinical skills on the wards so there was no clinical skills training program. There was no community practice experience, no training for office practice, no emphasis on collaboration with other health professionals, and no discussion of the social determinants of disease. They expected the graduate physician to have all these qualities, knowledge and skills, but the expectation was that we would acquire them by years of experience. These are all now part of the education of a future physician.

The hospitals in the late 1950s seemed modern, well-staffed and up to date. Again, looking back we can see how much has changed. The Victoria General Hospital, the most modern and largest teaching hospital, had a small emergency room, no intensive care unit, no dialysis unit, no cancer unit, no palliative care, no interventional radiology and no automated laboratory tests. A large hospital like the VGH looked like a large Holiday Inn with a radiology department and a few operating rooms. The administrative area was small with an administrator, a medical director, and a head of nursing, with their secretaries. Everything seemed to work well and there were no waiting lists.

General Practice

Most of my class went into general practice for a few years before deciding to make their life as family doctors or to return to postgraduate study. Some years in family practice was a valuable experience for a specialist and provided a lot of doctors to the community.

I spent two years as a solo family doctor in a small community, and although I loved the patients and the practice, the demands on a family doctor in that era were grueling and allowed little time for family or personal life. There was little time for continuing education. Days were long and I was always on call. An office visit was $3 and a house call was $5. Pre and postnatal care and delivery of a baby was $85. I delivered 200 babies during those years.

I was fully involved in hospital care, admitted and cared for my patients and assisted at surgery. Patients stayed in hospital for long periods, often for a series of daily tests. Cataract patients stayed for two weeks with their heads sandbagged so they wouldn’t move. Many of the patients in hospital were not very sick, and long periods of rest following procedures, childbirth and surgeries were routine.

If you worked all the time as a family doctor, and were always available and on call nights and weekends, you were regarded by the community as “the good doctor” but they didn’t notice how many physicians then had problems in their family and personal lives as a result.

There have been many changes. First, there is the remarkable quality of the current applicants to medical school, and we can take only a small fraction of them. Most students in medicine are women, and this has been a very positive change. Students will have to choose early whether to go into family medicine, or what specialty they will apply for, and there is no guarantee that they will get their choice. Hospitals are much busier places, with many services not seen in my early years, and most people are very sick, but the hospital stays are shorter. Most patients that would have been admitted to hospital in 1958 are now tested and treated as an outpatient.

In the 62 years since I entered medical school the changes in medicine have been dramatic in terms of the diseases now treatable, the tests available and the impact on population health and life expectancy.

On a personal note, in recent years I noticed a suspicious lump on my neck. It was investigated with CT scan, and then a PET scan. Following a diagnosis of lymphoma, I began a combination of therapies that have the promise of benefit and even cure. In the early part of my career, none of these tests and none of these therapies were available, and the disease was fatal.

Next week, in Part 2, I will discuss other changes in care, treatment and knowledge in medicine and some predictions and hopes for the future.