MEDICINE, SCIENCE, AND SOCIETY
My Son, the Doctor RICHARDS. PANUSH, M.D. Livingston, NewJersey
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ello?” H “ ‘Mitchele’? “Hi, Ma. How’rya
It’s vour Mother.” doing?” “I manage. How are the ‘kinder’?” “Pretty good. Rebecca’s enjoying her second year at college. It’s not as hard for us to adjust to her being away this year as it was last year. Now we store stuff in her empty room. I sure am glad we sacrificed to send her to Ivy League University where she takes a tough course load of Music, Art, Film, and Costume. Guess she really meant it when she said she wasn’t interested in Medicine!” “Maybe one of the boys will be a doctor?” “I doubt it, Ma. We’ll be relieved to see Joseph finish his last two years of high school. Can’t wait to get his drums out of the house; we’re all going deaf. If he lets his hair grow much longer, he’ll trip on it. No, not earrings, Ma-just one so far. Yes, Ma, he’s still circumcised. Yes, I know he’s a good boy.” “And the Baby?” “Ma, Daniel-the baby-is almost 14. He’s thriving in his first year of high school. Can you believe he loves the teachers, loves the classes, loves the homework? Maybe something’s wrong with him! He’s already president of student government and on the crosscountry team. He’s only practiced for one week and already I-who’ve been waiting 14 years for him to run with me-can’t keep up! Ma, how come it’s harder to bring up kids today than when we were young?” “Son, it wasn’t so easy then either. You forgot. Nu, how’s my favorite daughter-in-law, Rita?” “Great, Ma. Always busy. It’s tough for her to look after the house and kids and still try and maintain her career. Especially here in Sunneville where, you know, she hasn’t much opportunity.” “Do the dogs miss me?” “Sure, Ma. They’re OK. It’s amazing what $1,000 worth of surgery and treatments will do. Even though Rita threatens to get rid of them and Rebecca believes they have only three chromosomes, I enjoy them. They usually listen to me and never argue.” “So how was your day, Son?” “Just a minute, Ma, I’m having trouble hearing you; lemme turn the MTV down a few hundred decibels. There. Oh, pretty routine. I gave a lecture to the thirdyear medical students, worked on a grant, spent some time in my lab, worked on some papers, returned phone calls, and made travel arrangements for the meetings coming up.” “Is that what you learned in Medical School? Don’t you see patients?” From the University of Florlda College of Medicine, Gainesville, FlorIda, the Department of Medune, University of Medicine and Dentistry of New Jersey, New Jersey School of Medlclne, Newark, New Jersey, and the DepartDepartment of Medicine, St. Barnabas Medical Center, 94 Old Short Hills Road. LivIngston, New Jersey 07039. Manuscript submltted July 26, 1989, and accepted September 7, 1989.
“Well, not today, Ma. I’ve tried to explain to you that’s only part of what I do in academic Medicine. I guess you and Pa never really understood about research and teaching.” “Is that nice secretary of yours, Mary Beth, still there?” “Yeah. But she’s going to leave because there’s no way in our University system for me to pay her what she deserves and she can make more money elsewhere. I have a new lab technician to train, too; my old one left for a better-paying job.” “Mitch, the real reason I called is your Father. He’s having pains in his stomach. I’m worried. We’ll drive over to Sunneville tomorrow and you’ll take a look at him. What do you think it is?” “Ma, I can’t tell you over the phone. Besides you know my subspecialty isn’t stomachs.” “So then we’ll see your friend, Chuck, the stomach specialist, first thing.” “OK Ma, I’ll try and arrange something. But it’s hard on short notice. And tomorrow’s not his clinic day.” “What?” “Never mind, Ma. I’ll take care of it.” “You think he’ll be able to help?” “I hope so. But he doesn’t really specialize in stomach problems-he’s an expert in other kinds of intestinal disease.” “What? So maybe I should see someone else? Your friend who has a regular doctor’s office, Jean?” “No, Ma, I think Jean flies to one of his other offices tomorrow, probably at Sunshine Beach.” “Then maybe the other stomach doctor, Ken?” “No, Ma. He doesn’t see too many patients any more. He’s busy writing a book about how to take care of patients with stomach disease. And writing grants so his associates can do the research so he can write his book about it. Besides he’s away this week.” “Where is he?” “Lecturing somewhere. It pays pretty well you know. Every dollar helps when you have kids in college.” “Who pays for this?” “Usually the drug companies.” “You mean the people who make the drugs you prescribe? How can you take their money at the same time you have to decide which drugs to give patients?” “C’mon, Ma. We can’t be bought, although maybe we can be rented.” “Son, I may be old but I’m not senile. It doesn’t sound right. By the way, our Feldene umbrella has a hole in it. Can you get us another one? And some more of those nice pens and note paper? Also, your Father’s running out of Motrin.” “Sure, Ma. Lemme write it down.” “So, who takes care of Ken’s patients while he’s away?” “You know, Ma, most of us in full-time academic Medicine only see patients a few half-days per week.
Febl ruary
1990
The American
Journal
of Medicine
Volume
88
167
MY SON, THE DOCTOR
/ PANUSH
Besides, Ken’s pretty famous now so he spends a lot of time traveling and lecturing. In fact, he was the first person on our faculty to be named the airlines ‘traveler of the month’!” “So, if you and your friends dont’t take care of many patients, then who does?” “Mostly LMDs, Ma.” “What?” “LMDs-Local Medical Doctors they’re called. Some aren’t even too bad.” “So, if you don’t take care of patients, what do you do?” “I’ve tried to tell you, Ma. We do research and teach.” “Well, then, you’ve been doing research for nearly 20 years. Have you found the cure for arthritis yet?” “Ma, you know that takes time. We’re working on it. I have gotten a lot of grants though.” “Is that good?” “Sure, Ma. It got me promoted. I also wrote several hundred papers.” “But son, how many of them were important?” “We teach too, Ma.” “How do you do that?” “Well, Ma, we give lots of lectures to students and doctors in training. And they tell us about the patients who are in the hospital and then we then discuss it together.” “Oh, with the patients?” “No, usually in a conference room.” “Son, it seems to me that that teaching should take place where the patients are.” “But then it’s hard to talk about the lab tests and look at all the x-rays and scans. And we have to sign all the charts and forms so the hospital can bill. The Dean says that’s important too.” “That’s nice, Son. But I still don’t understand how you can be a doctor and not take care of sick people or teach others how to.” “I explained, Ma, we’re busy with other things.” “Son, I’m confused. So tell me, they taught you
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1990
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about these grants, papers, promotions, gifts, the drug companies, and traveling in Medical School?” “No, Ma, not unless I missed those days. Maybe some of us get too caught up in our careers sometimes.” “And your research-you won’t win the Nobel Prize? I look for your name in the paper each year.” “It doesn’t look good, Ma. Maybe we find it hard to see that our research may not be as important as we hoped.” “And the other doctors? These ‘LMDs’ you call them? They’re all schnooks?” “No, Ma. Some of them are even my best friends! Maybe we sometimes forget that other doctors doing other things can be good too.” ‘Son, you’re not making sense. What kind of boy did I send to college?” “OK, Ma. Maybe we sometimes lose sight of what Medicine is about-caring for the sick and transmitting our knowledge and skills to future generations of physicians.” “Son, what are you trying to say?” “Maybe we forget how important and rewarding patient care and medical education can be.” “Son, if you did that we’d be so proud-then you’d finally be a real doctor!” “See you tomorrow, Ma. Drive carefully. Oh, by the way, see if you can find my old golf clubs and bring them over.” “No greater opportunity, responsibility or obligation can fall to the lot of a human being than to become a physician. In the care of the suffering, he needstechnical skill, scientific knowledge and human understanding. He who usesthese with courage, with humility and with wisdom will provide a unique service for his fellow man and will build an enduring edifice of character within himself. The physician should askof his destiny no more than this; he should be content with no less.” (Stead EA Jr: What this patient needs is a doctor. Wagner GS, Cebe B, Rozear MR, eds. Durham, North Carolina: Carolina Academic Press, 1978; 142.)
88
My Son, the Doctor RICHARDS. PANUSH, M.D. Livingston, NewJersey
cc
ello?” H “ ‘Mitchele’? “Hi, Ma. How’rya
It’s vour Mother.” doing?” “I manage. How are the ‘kinder’?” “Pretty good. Rebecca’s enjoying her second year at college. It’s not as hard for us to adjust to her being away this year as it was last year. Now we store stuff in her empty room. I sure am glad we sacrificed to send her to Ivy League University where she takes a tough course load of Music, Art, Film, and Costume. Guess she really meant it when she said she wasn’t interested in Medicine!” “Maybe one of the boys will be a doctor?” “I doubt it, Ma. We’ll be relieved to see Joseph finish his last two years of high school. Can’t wait to get his drums out of the house; we’re all going deaf. If he lets his hair grow much longer, he’ll trip on it. No, not earrings, Ma-just one so far. Yes, Ma, he’s still circumcised. Yes, I know he’s a good boy.” “And the Baby?” “Ma, Daniel-the baby-is almost 14. He’s thriving in his first year of high school. Can you believe he loves the teachers, loves the classes, loves the homework? Maybe something’s wrong with him! He’s already president of student government and on the crosscountry team. He’s only practiced for one week and already I-who’ve been waiting 14 years for him to run with me-can’t keep up! Ma, how come it’s harder to bring up kids today than when we were young?” “Son, it wasn’t so easy then either. You forgot. Nu, how’s my favorite daughter-in-law, Rita?” “Great, Ma. Always busy. It’s tough for her to look after the house and kids and still try and maintain her career. Especially here in Sunneville where, you know, she hasn’t much opportunity.” “Do the dogs miss me?” “Sure, Ma. They’re OK. It’s amazing what $1,000 worth of surgery and treatments will do. Even though Rita threatens to get rid of them and Rebecca believes they have only three chromosomes, I enjoy them. They usually listen to me and never argue.” “So how was your day, Son?” “Just a minute, Ma, I’m having trouble hearing you; lemme turn the MTV down a few hundred decibels. There. Oh, pretty routine. I gave a lecture to the thirdyear medical students, worked on a grant, spent some time in my lab, worked on some papers, returned phone calls, and made travel arrangements for the meetings coming up.” “Is that what you learned in Medical School? Don’t you see patients?” From the University of Florlda College of Medicine, Gainesville, FlorIda, the Department of Medune, University of Medicine and Dentistry of New Jersey, New Jersey School of Medlclne, Newark, New Jersey, and the DepartDepartment of Medicine, St. Barnabas Medical Center, 94 Old Short Hills Road. LivIngston, New Jersey 07039. Manuscript submltted July 26, 1989, and accepted September 7, 1989.
“Well, not today, Ma. I’ve tried to explain to you that’s only part of what I do in academic Medicine. I guess you and Pa never really understood about research and teaching.” “Is that nice secretary of yours, Mary Beth, still there?” “Yeah. But she’s going to leave because there’s no way in our University system for me to pay her what she deserves and she can make more money elsewhere. I have a new lab technician to train, too; my old one left for a better-paying job.” “Mitch, the real reason I called is your Father. He’s having pains in his stomach. I’m worried. We’ll drive over to Sunneville tomorrow and you’ll take a look at him. What do you think it is?” “Ma, I can’t tell you over the phone. Besides you know my subspecialty isn’t stomachs.” “So then we’ll see your friend, Chuck, the stomach specialist, first thing.” “OK Ma, I’ll try and arrange something. But it’s hard on short notice. And tomorrow’s not his clinic day.” “What?” “Never mind, Ma. I’ll take care of it.” “You think he’ll be able to help?” “I hope so. But he doesn’t really specialize in stomach problems-he’s an expert in other kinds of intestinal disease.” “What? So maybe I should see someone else? Your friend who has a regular doctor’s office, Jean?” “No, Ma, I think Jean flies to one of his other offices tomorrow, probably at Sunshine Beach.” “Then maybe the other stomach doctor, Ken?” “No, Ma. He doesn’t see too many patients any more. He’s busy writing a book about how to take care of patients with stomach disease. And writing grants so his associates can do the research so he can write his book about it. Besides he’s away this week.” “Where is he?” “Lecturing somewhere. It pays pretty well you know. Every dollar helps when you have kids in college.” “Who pays for this?” “Usually the drug companies.” “You mean the people who make the drugs you prescribe? How can you take their money at the same time you have to decide which drugs to give patients?” “C’mon, Ma. We can’t be bought, although maybe we can be rented.” “Son, I may be old but I’m not senile. It doesn’t sound right. By the way, our Feldene umbrella has a hole in it. Can you get us another one? And some more of those nice pens and note paper? Also, your Father’s running out of Motrin.” “Sure, Ma. Lemme write it down.” “So, who takes care of Ken’s patients while he’s away?” “You know, Ma, most of us in full-time academic Medicine only see patients a few half-days per week.
Febl ruary
1990
The American
Journal
of Medicine
Volume
88
167
MY SON, THE DOCTOR
/ PANUSH
Besides, Ken’s pretty famous now so he spends a lot of time traveling and lecturing. In fact, he was the first person on our faculty to be named the airlines ‘traveler of the month’!” “So, if you and your friends dont’t take care of many patients, then who does?” “Mostly LMDs, Ma.” “What?” “LMDs-Local Medical Doctors they’re called. Some aren’t even too bad.” “So, if you don’t take care of patients, what do you do?” “I’ve tried to tell you, Ma. We do research and teach.” “Well, then, you’ve been doing research for nearly 20 years. Have you found the cure for arthritis yet?” “Ma, you know that takes time. We’re working on it. I have gotten a lot of grants though.” “Is that good?” “Sure, Ma. It got me promoted. I also wrote several hundred papers.” “But son, how many of them were important?” “We teach too, Ma.” “How do you do that?” “Well, Ma, we give lots of lectures to students and doctors in training. And they tell us about the patients who are in the hospital and then we then discuss it together.” “Oh, with the patients?” “No, usually in a conference room.” “Son, it seems to me that that teaching should take place where the patients are.” “But then it’s hard to talk about the lab tests and look at all the x-rays and scans. And we have to sign all the charts and forms so the hospital can bill. The Dean says that’s important too.” “That’s nice, Son. But I still don’t understand how you can be a doctor and not take care of sick people or teach others how to.” “I explained, Ma, we’re busy with other things.” “Son, I’m confused. So tell me, they taught you
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February
1990
The American
Journal
of Medicine
Volume
about these grants, papers, promotions, gifts, the drug companies, and traveling in Medical School?” “No, Ma, not unless I missed those days. Maybe some of us get too caught up in our careers sometimes.” “And your research-you won’t win the Nobel Prize? I look for your name in the paper each year.” “It doesn’t look good, Ma. Maybe we find it hard to see that our research may not be as important as we hoped.” “And the other doctors? These ‘LMDs’ you call them? They’re all schnooks?” “No, Ma. Some of them are even my best friends! Maybe we sometimes forget that other doctors doing other things can be good too.” ‘Son, you’re not making sense. What kind of boy did I send to college?” “OK, Ma. Maybe we sometimes lose sight of what Medicine is about-caring for the sick and transmitting our knowledge and skills to future generations of physicians.” “Son, what are you trying to say?” “Maybe we forget how important and rewarding patient care and medical education can be.” “Son, if you did that we’d be so proud-then you’d finally be a real doctor!” “See you tomorrow, Ma. Drive carefully. Oh, by the way, see if you can find my old golf clubs and bring them over.” “No greater opportunity, responsibility or obligation can fall to the lot of a human being than to become a physician. In the care of the suffering, he needstechnical skill, scientific knowledge and human understanding. He who usesthese with courage, with humility and with wisdom will provide a unique service for his fellow man and will build an enduring edifice of character within himself. The physician should askof his destiny no more than this; he should be content with no less.” (Stead EA Jr: What this patient needs is a doctor. Wagner GS, Cebe B, Rozear MR, eds. Durham, North Carolina: Carolina Academic Press, 1978; 142.)
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