Dr. Stephen R. Keister : Christmas Spirit and the Compassionate Doctor

“The Family Doctor,” lithograph by Grant Wood, 1941.

Christmas past:
The compassionate doctor
and today’s medical culture

By Dr. Stephen R. Keister / The Rag Blog / December 22, 2010

The Christmas season means many things to many people; however, as I approach age 90 I tend to reflect on what was and what might have been. Christmas to me represents a time of giving — not of material things, but of kindness and compassion.

Many of the modern day fundamentalist “Christians” might feel disdain for those of us who are secularists — and believers in a code of secular ethical culture. But to me the largest concepts of Christian morality lie within Matthew 5:1-12 (The Beatitudes), Luke 10:25-37 (The Parable of The Good Samaritan), and Matthew 19:23-26, (Jesus’ tale of the possibility of a rich man entering the Kingdom of Heaven).

I would like to reflect on two outstanding physicians that I have known who I believe embody that spirit.

Dr. William Watt Graham Maclachlan was my mentor during my period of residency in internal medicine at Mercy Hospital in Pittsburgh, 1945-1950. Dr. Maclachlan was some 60 years of age, a graduate of McGill when the tradition of Sir William Osler still persisted there, a member of the Association of American Physicians with its membership of 50 outstanding doctors nationally, and personal physician to two diverse personalities, Andrew Mellon and Philip Murray of the National Steelworkers.

Dr. Maclachlan’s great love was teaching and caring for the folks in the charity wards, especially those in the pneumonia ward where he supervised much of the early work with penicillin in treating lobar pneumonia, a disease that then carried a 50% fatality rate. The pneumonia ward was populated largely by residents of two local refuge houses, most of them alcoholics, who were admitted in dire straights and in many cases with little hope of recovery.

Dr.Maclachlan would pause at each bedside, check the individual’s name on his chart, pull up a chair, grasp the man’s hand, address him by his last name, and reassure him of his progress and care. It was from him that I learned to appreciate the true objective of the physician, love and consideration for the individual as a human being. In due time Dr. Maclachlan inspired me to become a rheumatologist, before such a specialty formally existed. and thus gave me a purpose for my life during the years 1950-1990.

At this season I think often of the privilege I had in knowing such a wonderful, far-sighted, compassionate human being.

Another person who I will always remember is Dr. Hyman Casselman, lovingly known as “Casey.” I met Dr. Casselman in 1950 or thereabouts, when I opened practice in Erie, Pennsylvania. Casey was a Canadian, also trained at McGill, who had interned in Erie, married a local lady of considerable means, and settled here to work as a family physician. During World War II he was assigned to an army dispensary in Arlington, Virginia. where his patients proudly included Generals Marshall and Eisenhower — before they had achieved full military rank.

Casey was the physician for the underprivileged, the poor and neglected, in the Erie area. He made house calls day and night in all kinds of weather and he never pushed a family for payment. His primary concern was for the well-being of the individuals and their families, not for his financial gain.

He never had a big house in the affluent section of the city. I remember encountering an elderly Afro-American who looked me in the eye and proudly said, “Dr. Casselman is my family doctor.” Casey was one of the few physicians who joined me in opposing the Vietnam War. I was proud to have such a partner in my personal and very lonely rebellion. I was also proud, in Casey’s later days, to be asked to present him with the Maimonides Award. Casey died at the age of 92 in 1998.

These two gentleman would be entirely befuddled by today’s medical culture where, upon entering a physicians office, you are immediately asked for your insurance card and asked to sign a bunch of papers having to do with financial and legal liability. You are then paged by your given name as if the receptionist/nurse were an old acquaintance, and escorted into an examining room where you are interviewed by a physician’s assistant.

No more of this sitting down and talking to the doctor for 45-60 minutes on the first visit and developing a personal friendship. Finally, if fortunate, one is able to spend 15-20 minutes with the physician, who may well be taking notes on a laptop during the interview. Sometimes you are even granted the opportunity to ask questions before being hurried out the door to set up your next appointment.

I have personally been fortunate, and I do not believe that it is because I am a physician, to have had the privilege of communicative, caring doctors (very much an exception these days) as my personal internist, my pain management physician, and an oncologist at our outstanding Regional Cancer Center.

Since the health insurance industry takeover of medical care in the United States — as we have noted in prior dispatches on The Rag Blog –- medicine has been transformed from a profession into a business not unlike those designed to sell insurance or used cars.

In the present culture of greed and materialism in the United States I see very little hope for our reverting to what we once were, or transforming our health care system into what exists in many other nations of the world. There appears to be little political interest, for instance, in establishing a single payer, universal health care system, as is promoted by Physicians for a National Health Program or the American Nurses Association.

In case you missed it, I would call everyone’s attention to an extensive and impressive document published on Mother Jones online. It’s the International Federation of Health Plans’ “2010 Comparative Price Report, Medical and Hospital Fees by Country.” We should become familiar with the information in this report if we indeed some day hope to join the rest of the world — with first rate care at reasonable costs.

There are only two nations in the industrialized world with “socialized medicine” — Canada and the UK — and 93% of Canadians are reported to be happy with their program. The UK program is a bit in flux under the current Tory Government and I have seen no recent statistics on satisfaction. The remaining nations have programs based on private health insurance with government oversight of costs and services.

I look to the future with more fear than I have experienced since the days of Sen. Joe McCarthy. The Obama administration, in spite of the howls from the political right, has little in common with the progressive America of the LaFolletts, Norman Thomas, and Franklin D.Roosevelt.

There is little hope of obtaining again our once national greatness under a Congress and Senate dominated by the corporations and their mainstream media shills. It seems to me a paradox that Obama is so hated by the mass of the conservative movement when in essence he is in bed with the majority of their policies.

One must surmise then that the dislike is based on his being seen as “the other” by a poorly informed, television-hypnotized public — a public which lives largely in a world noted for what Hannah Arendt called “the totalitarian contempt for facts and reality.” It was Joseph Goebbels who said, “It is the absolute right of the State to supervise the formation of public opinion.”

Finally, as a “senior citizen” I am aghast at the commercial efforts to take advantage of the elderly population with contrived misinformation like the massive advertising campaign to sell Medicare Advantage Plans in place of normal medicare to the senior population. This advertising costs millions of dollars, all to be passed on to the poor devil who buys the junk.

And the unending barrage of pharmaceutical ads on TV! The pharmaceutical industry, which spends more on advertising than on research, is passing on the costs to the buyer with this flow of undocumented foolishness. “Be sure and tell your doctor if you have diabetes or high blood pressure.” Goodness, if your doctor is not aware that you have high blood pressure or diabetes it is time you change doctors.

Happy Holidays to all.

[Dr. Stephen R. Keister lives in Erie, Pennsylvania. He is a retired physician who is active in health care reform and is a regular contributor to The Rag Blog.]

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5 Responses to Dr. Stephen R. Keister : Christmas Spirit and the Compassionate Doctor

  1. HOSEA W MCADOO M.D. says:

    Dr, Keister,

    Thank you for for another peek into medicine. i totally agree with your views.

    I t may come as a surprise to most citizens and many physicians that the greatest reward in medicine is not monetary but the thank you of a grateful patient.

    I remain very concerned and saddened that so many see medicine as a business to be doled out to those able to pay like some luxury. This attitude defeats the very basis for the practice of medicine.

  2. Harvey M. Solomon says:

    Dear Dr. Keister:
    Thank you for recalling a time when doctors were able to spend time with their patients and learned more about them than the history of their chief complain. My father was a physician who completed his training in 1929 and became a general practioner in East Baltimore, an old industrial part of the city. He had office hours, then made house calls, had a quick lunch and then spend the remainder of the long day in the office seeing patients. When the telephone rang at night there was no recording telling the patient to go to the emergency room; he spoke to all of them. I can remember him leaving in the middle of the night to perform home deliveries. His patients held him in the highest regard and he greatly enjoyed interacting with them.
    I went to medical school in the mid 1950’s. We were trained to take and extensive medical history and perform a thorough physical examination.Our teachers prided themselves on the findings that a good physical examination could reveal. Other than Thorazine and penicillin, most of our medications were derived from botanical and animal sources. I remember when we started getting gifts from pharmaceutical companies and how displays of new pharmaceutic products began to appear and be hawked in the doctor’s lounges. Over time a significant transition took place in which the emphasis in clinical medecine seemed to shift from careful diagnosis to the treatment of symptoms with the latest, most expensive wonder drugs. I found myself becoming much more interested in the diseases than in this form of treatment so I shifted from internal medicine to pathology, I believe it was a very wise choice.
    These days I obtain my health care from a fine family practice physian. Because of the government and the insurance companies he has to work like a hamster in an exercise wheel. A routine visit lasts, fifteen minutes, at most, and when I offer to remove my shirt for an examination of my heart and lungs he tells me there is no need to do so. He does use an electronic record, has all his medications included their side effects in his little hand held computer and can calculate my cretinine clearance automatically. These are certainly good technical advances but the price has been a serious decrease in what used to be called the doctor patient relationship. When I became a physician I had no concept of how it would be changed into a corporate dominated, and degrading experience for both the patients and doctors. Retirement has brought a tremendous relief.

  3. HOSEA W MCADOO JR says:

    Dr. Harvey M Solomon.

    Your comment was a statement of te way medicine should be.

    Both Dr. Keister and I would like to communicate with you. Please advise Dr. Keister via The Rag Blog.

    Thank you.

  4. Anonymous says:

    Thank you Dr. Keister for remembering and reminding us of what we have lost while being led down the garden path.

  5. Anonymous says:

    I have enjoyed Dr. Keister’s many different articles. Since I am not in the medical field, his articles have been enlightening and very encouraging. Hearing from a physician of his status who “lays it on the line” honestly has been a great privilege. Thank you Dr. Keister!

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