Editor’s note: The following is the first submission to a new column titled “From residency to retirement” that will be published periodically in the Bulletin. The column is intended to provide an opportunity for surgeons at every stage of their career to share their thoughts regarding the practice and profession of surgery.
If you are interested in contributing to this new column, contact Diane Schneidman, Editor-in-Chief, Bulletin of the American College of Surgeons, at firstname.lastname@example.org.
The June 2012 issue of the Bulletin featured a news story indicating that 90 percent of 5,000 physicians who participated in a study conducted by The Doctor’s Company were unwilling to recommend health care as profession.* This appalling statistic, compared with the mindset that existed when I graduated from medical school 68 years ago, made me stop to reflect on my own experiences and on the question, “Is medicine still a good profession?”
Some colleagues of my generation have also expressed the view that we practiced medicine during its golden era. They say that—considering the problems that exist today—they too would be reluctant to recommend medicine as a profession to a family member.
It’s true that major changes have occurred in medicine in the last six or seven decades, and some of them have been undesirable. However, I really believe that when one considers the amazing advancements that have occurred, it is apparent that every generation of surgeons is part of a golden era. Anyone who wants to serve other people, or who has an interest in understanding how the human body functions or in unraveling its mysteries, should be encouraged to pursue this field. As an additional advantage, no profession surpasses medicine for the caliber of people with whom we work and socialize.
Surgery has certainly undergone many changes and many more surely will come. Some will be bad, and some will be good. One negative change that comes to mind is the loss of pride in our work. Unfortunately, some of the restrictions that have been forced upon surgeons in recent years have led to a deterioration of the physician-patient relationship that really makes the practice of medicine special.
Examples of these constricting forces include increased supervision by institutional review boards (IRBs) and expanded use of patient consent forms. The latter are certainly essential and beneficial, and, on the whole, IRBs are desirable but sometimes create unnecessary roadblocks.
Likewise, peer review of manuscripts submitted to medical and surgical journals is often helpful, but some authors have been the victim of overzealous reviewers. Along this line, I am reminded of the work performed by Edward R. Woodward, MD, demonstrating that a hormone release from the gastric antrum was under pH control. All of the best surgical journals rejected the paper. It was finally accepted by Gastroenterology.† Arguably, this study was among the most important to originate in the laboratory of Lester Dragstedt, MD, FACS, in the mid-1940s. However, its publication was delayed several years because some surgical reviewers happened to disagree with the findings. My point is that no rule or well-intentioned safeguard is perfect, but, on the whole, most provide some benefit.
In spite of these challenges, my generation feels that we practiced medicine during its best days. Of course, retired physicians of every generation probably think they practiced in the golden era of medicine. But consider the next generation and the unbelievable tools they have at their disposal. Aren’t these surgeons likely to think they practiced during the golden age when they retire?
The shoulders of giants
Is there any reason, other than administrative disenchantment, why surgeons should discourage young people from considering a career in medicine? The answer, in my opinion, is that there is not. If an individual has the desire to help mankind and contribute to society and has an inquisitiveness to learn or discover how the human body functions, he or she should be encouraged to consider the field of medicine.
Above and beyond the factors that motivate medical students, this profession provides role models and friendships that are as strong as they are in any profession. I have been privileged to associate with people who are the kindest, smartest, and most noble individuals. And, if ever the metaphor “dwarves standing on the shoulders of giants can see further” could be applied to a profession, it would certainly be relevant to the field of medicine.
Some individuals who inspired me—a few of the giants on whose shoulders I have had the opportunity to stand—are addressed in the following section.
I matriculated at the University of Chicago, IL, which began to develop its own medical faculty in 1925. Dallas B. Phemister, MD, FACS, FRCS(Hon), a prominent surgeon at Presbyterian Hospital in Chicago, was named the first chief of surgery. One of the unique features of the school was that the faculty was full time. Although full-time faculties eventually became the pattern at medical schools throughout the U.S., the only other medical school that purportedly had full-time faculty then was Johns Hopkins University.
The surgical faculty was composed almost entirely of general surgeons. Dr. Phemister had a strong interest in orthopaedics. He first described aseptic necrosis of bone and developed the first classification of bone tumors. He collaborated with Alfred Blalock, MD, FACS, at Vanderbilt University, Nashville, TN, on the study of hemorrhagic shock and was instrumental in establishing the first blood bank in the U.S. at Cook County Hospital in Chicago.
At this time, Dr. Dragstedt was head of physiology at Northwestern University, also in Chicago. Dr. Phemister asked him to design the dog lab in the new school and eventually offered Dr. Dragstedt a position on the surgical faculty. Dr. Dragstedt replied that he was not a surgeon, he was a physiologist. Dr. Phemister allegedly responded by saying that it was easier for him to make a surgeon out a physiologist than a physiologist out of a surgeon. With that, Dr. Dragstedt was sent to Europe to visit and work in many of the famous surgery clinics before returning to the University of Chicago to join the surgical faculty.
Hilger Perry Jenkins, MD, FACS, also a general surgeon, had an interest in plastic surgery and eventually became the chair of that department. An interesting story relates to Dr. Jenkins conducting the live surgical television programs at the Clinical Congress. In 1955, Robert Zollinger, MD, FACS, called Dr. Jenkins and said he would like to present a woman who had undergone multiple operations for a duodenal ulcer. Dr. Jenkins said that would be an interesting case to present but to look for a pancreatic tumor. Sure enough, this patient had the first described Zollinger-Ellison tumor. Dr. Zollinger subsequently gave Dr. Jenkins credit for his advice.
Then there was Charles B. Huggins, MD, FACS, also a general surgeon, who became chair of urology at the University of Chicago and subsequently won the Nobel Prize for his work on the hormonal relationship to carcinoma of the prostate. You can begin to appreciate the development of specialization that was bound to occur in medicine and surgery when you consider the explosive development of new devices and techniques.
By this time, Hitler had become very aggressive. Japan had attacked Pearl Harbor, and the U.S. responded with a declaration of war. As a result, the University of Chicago campus was filled with all types of scientists, including the nuclear physicists who initiated the first successful chain reaction that led to the atomic bomb. This growth led to a housing shortage, and the faculty was asked to open their homes to students. Dr. and Mrs. Phemister had a beautiful three-story home on University Avenue, and I was privileged to live on the third floor next to Dr. Phemister’s library, of which he was very proud. When he brought a guest to see his library, they would pass my door and Dr. Phemister would say, “Shush, Paul is studying.” I never figured out whether he knew something I did not, or whether he was suggesting in a gentle way that I might try a little harder.
There was no question that because of living with the Phemisters until I graduated, and because of the close friendships I formed with other students who chose surgical careers—including George Nardi, MD, FACS; Robert Jamplis, MD, FACS; and Henry McWhorter, MD, FACS—I, too, decided to go into surgery, and so began my golden era.
It is my sincere hope that I have been a role model to medical students and residents. I have often encouraged young people to consider a MD-PhD program, which provides greater opportunities for professional growth in the future. Young people usually do not know whether research is of interest until they have had an opportunity to discover its excitement.
A good profession
If you want to evaluate your legacy in medicine, you might consider, as one guide, the last paragraph in the autobiography of Loyal Davis, MD, FACS. Dr. Davis was the first neurosurgeon to practice in Chicago. He was profoundly instrumental in the development of the American College of Surgeons and ardently advocated for the College to take a strong stand against fee-splitting—one of the scourges of medicine and surgery. In his autobiography, titled A Surgeon’s Odyssey, Dr. Davis wrote, “I should like to believe that I have contributed to the happiness, future, success, and well-being of my family, professional colleagues, students and patients. If these are the thoughts of an old man, I accept the accusation. But if at some time in the future my relatives, my contemporaries, and my young friends in surgery speak with each other about my failings, my virtues, and my accomplishments, I shall have made it.”‡
Medicine, indeed, was a good profession, and so long as young physicians have the shoulders of giants on which to stand, it will continue to be a good profession for dedicated individuals.
*Survey reveals most physicians unwilling to recommend health care as a profession. Bull Am Coll Surg. 2012;97(6):49. Accessed November 20, 2012.
†Woodward ER, Lyon ES, Lander J, Dragstedt LR. The physiology of the gastric antrum; experimental studies on isolated antrum pouches in dogs. Gastroenterology. 1954;27(6):766-785.
‡Davis L. A Surgeon’s Odyssey. Garden City, New York: Doubleday & Co; 1973.