~ By a Pediatrician in Australia
Societal attitudes, scientific progress and an increased understanding of how the human body works in lay people, have transformed the way Medicine has been practiced over the years. Each transformation brings with it challenges and opportunities, particularly for the treating doctor. The rise of lawsuits, corporate health care and financial reforms are some examples of pressures on the doctor-patient relationship. While we embrace partnership with our patients, there is a logistical simplicity and ease with the traditional ‘paternalistic’ practice of Medicine a century ago. As a medical student I was told that informed consent meant that the doctor was informed and just had to obtain consent from the patient!
For the sake of practicality I am breaking modern medical practice into the following ‘eras’:
- Paternalistic – (eg pre-1960s) – the doctor was godlike and wrote prescriptions in French/Latin (‘The Tablets’) that patients didn’t understand and deferred to their advice, eg a doctor advising patient to wear a cotton singlet, drink flat lemonade, eating an apple a day, ‘starve a fever, feed a cold’ sayings, etc. A shot of medicinal brandy for ‘shock’. Private billing.
- Pharmacological – (eg 1960s-1980s) – pills were the answer to most ills. Introduction of vitamin supplements. ‘Medicalisation’ of mental illness (and later rise of Prozac), alcoholics were a ‘victim’ of their illness and not responsible for their actions, debut of the Oral Contraceptive Pill (emancipation of women), benzodiazepines for sleep, anxiety, etc. Introduction of bulk-billing. Patients still have usual doctor.
- Genetic – (eg 1990-2000s) – human genome mapped, rise of biological drug therapies, stem cell possibilities, knowledge of epigenetics/pharmacogenomics, cloning, etc. Patients may not have usual doctor but tend to frequent same medical practice. Significant rise in Evidence-based Medicine (EBM).
- ‘New Age’ – (eg 2010s onwards) – revival of Descartes’ mind-body dualism: mindfulness and meditation thought to be as effective as medication (potentially altering structural brain changes), diet and nutritional supplements just as potent as medicines, patients now in ‘partnership’ with doctors (seen as service providers), rise of Dr Google, doctor shopping.
- Traditional/cultural – (always been around) – naturopathy, Eastern philosophies, non-Evidence Based Practice, herbal supplements, unlicensed practitioners, ‘old wives tales’, etc.
Obviously there is a degree of overlap between each group and I am not criticising or dismissing one ‘era’ in preference of the other. (It is a moot point anyway, like stating that classical music is better or worse that pop music – everyone has their own opinion which is shaped by personal preference, experience and when your grew up). Rather I am just listing coarse groupings to allow for poll data.
Now as a doctor, think back to when you were happiest and/or the best doctor you could be. Was it as an enthusiastic medical student with a bright future ahead of you, a busy intern where no two days were the same, a keen registrar whose brain was filled to bursting capacity with knowledge of rare diseases to pass exams, a new consultant starting off in private practice, working in a hospital, performing locums in the middle of nowhere, working as an administrator or educator, or working comfortably pre-retirement where experience has taught you that there is little new under the sun?
Chances are you had a golden age being a doctor…
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