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from their patients, and that according
to Hippocrates, physicians should
have a primary interest in caring for
sick people.
"Yeah, but, like, wasn't Hippocrates
more of a medical philosopher?
I mean, nobody could cure diseases
back then, right?" was her reply.
I wasn't expecting such a harsh
indictment of the father of modern
medicine, the first doctor to understand
opium addiction and to recognize
the nature of epidemics like
malaria. After all, Hippocrates wrote
most of what the earliest medical
schools taught.
"Γm majoring in chemistry so I
can get into an MD/PhD program,"
proudly proclaimed another budding
chemistry major. He'd arrived at
Cornell with advanced placement in
several subjects, and was racing
through our curriculum at an accelerated
pace.
I asked what sort of medicine he
wanted to practice. "Academic," was
all he said.
What about taking care of patients?
I asked him.
"I want to do research on molecular
medicine," he countered, "not just
clinical stuff."
More premedspeak: I don't want
to be around sick people. I thought of
Galen, follower of Hippocrates, who,
while ministering to the gladiators of
the Roman Empire, not only developed
a practical knowledge of anatomy
but also happened to discover
that arteries carried blood, not air,
as his contemporaries thought. I remembered
Avicenna, the 10th century
Islamic "Prince of Physicians"
who composed the first medical encyclopedia
from extensive clinical
notes he compiled while travelling
throughout Persia. In his Arabian
dispensary, the forerunner of modern
drugstores, Avicenna formulated
Pharmaceuticals out of gold, silver
and other heavy metals to cleanse the
blood of impurities. The giants of
medical history, it seems, have been
practicing "molecular" medicine and
treating sick people for at least a
thousand years.
Although many of today's premeds
profess commitment and idealism,
70 percent still expect to be
specialists, disdainful of the primarycare
providers around whom our
healthcare system is being reorganized.
What words of advice might
history's legendary physicians offer
these aspiring young doctors as they
enter modern medical practice? What
would Hippocrates, etal. have to say
about healthcare reform, about physicians'
associations and hospital
conglomerates and managed competition?
Five hundred years ago, Phillipus
Aureolus Threophrastus Bombastus
von Hohenheim, who called himself
Paracelsus (literally, "above Celsus"
the renowned first century Roman
doctor), presided over a similar revolution
in healthcare. Traveling
throughout Europe and Asia Minor,
the itinerant physician boldly challenged
the medieval teachings of
Hippocrates, arguing that diseases
were caused by specific external
pathogens, not by vague imbalances
of "humors" in the body. Although
he was a successful surgeon, much
in demand by the wealthy aristocracy,
he shunned the attendant political
clout and espoused the peasant
lifestyle.
As a young professor of medicine
in Basel, the activist Paracelsus once
burned Avicenna's encyclopedia in a
public bonfire, and used medical
rounds as a forum to attack the profiteering
and pomposity of incompetent
doctors. That "the high colleges
managed to produce so many high
asses" reflected the depth of Paracelsus's
disdain for the prevailing
medical establishment.
Today, the prevailing premedical
mentality is evident in the
culture and language of premedspeak.
Most are shocked
and puzzled by the unorthodox
background and behavior of
history's greatest physicians, doubting
that any of them would now be
accepted into medical school. Of
Paracelsus's bombastic style, one remarked,
"He certainly doesn't sound
like a caring and compassionate physician."
Another was struck by the
similarity between Galen's experience
in Roman times and modern
inner-city emergency rooms. "Good
summer work experience," he
quipped. "But today's med schools
would still want to see Galen's
MCAT scores."
JUNE 1994
13
Maybe instead of fretting over
healthcare costs, we should be more
worried about the doctors who will
practice the reformed healthcare of
the future. The late Lewis Thomas,
a distinguished medical doctor and
superb writer who was long affiliated
with Cornell's Medical College and
Sloan-Kettering Research Institute,
understood the broad public appeal
of the physician's ability to cure. But
he also knew a few things about tending
to the sick to ease their pain, and
especially about bedside manner—
things he tried to pass on to young
doctors in his books. inLives of a Cell
he wrote, "The great secret, known
to internists and learned early in
marriage by most internists' wives,
but still hidden from the general
public, is that most things get better
by themselves. Most things, in fact,
are better by morning."
And what if things don't get better?
It may be, as Thomas suggests,
that we are all destined to die according
to some preordained schedule,
doctor's orders notwithstanding. I
cling to this notion as legions of prospective
premed, predental and MD/
PhD students muddle through introductory
organic chemistry. Perhaps
one of my advisees put it best this
year. We were arguing about the
changing stature and lifestyle of the
primary care physician, an occupation
whose ranks he desperately
hopes to join. Are you expecting to
make big bucks? I asked him. You
know, you won't have much autonomy.
His reply: "At least the job
will pay reasonably well."
That worries me.
—Bruce Ganem
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