One Doctor's Dignity

Anne-Louis Girodet (de Roucy-Trioson) (1767-1824)
Raphael Urbain Massard (engraver)
Hippocrates Refusing Gift from Alexander
20.5 x 25.5 inches, sheet (Paris: 1816)

To Hillary Clinton and Barack Obama:

I would like you to read the following. I didn't write it--my mother did. She was Hungarian: a European-trained doctor who received her medical degree in Paris in 1940. One of her aunts had become the third woman doctor in Hungary (though she never practiced, as she married a wealthy man). My father--also a doctor--got her out of Europe in 1941; they proceeded to live in Cuba (my father's homeland) for the next nineteen years. I was born in 1954. In 1960, we arrived in the United States. My mother had been a housewife for twenty-five years when she decided to take the foreign medical exam--the ECFMG, as it was called--in 1965. We were living in Georgia at the time. She passed the first time; went on-staff at the state hospital in the town where we lived; and, in 1967, she began a residency in psychiatry. She was 54 years old. When she finished her residency three years later, she rejoined us in Florida. Two years later, when I went off to college, circumstances led to her landing a job at South Florida State Hospital. She was 59 years old. She worked at SFSH until she retired at age seventy. My mother was an extraordinary woman: principled; dauntless; with a privileged and exquisite mind. She was also extremely practical. She was also fascinated with politics; with current events; with progressive ideas, culling them from all of her constant and voracious reading. She was a true product of her generation, "The Greatest Generation," (she was born in 1913). She kept news clippings and notebooks about almost anything and everything. By the way, she voted for Bill Clinton in 1996, causing a severe rift with another member of her generation, a dear lady who's now in a nursing home (and who has forgiven her, I think).

Some time during the 1990's, she shared the following with me (and I haven't overly-edited: English was technically her fifth language): "About doctors." Among the many changes the world experienced through the 20th century, the changes of medical practice are among the most significant. Physicians used to be involved with the patients personally--they made home deliveries, home calls, they even operated on kitchen tables: simple things like tonsils and appendix. They often worked pro bono and in my generation who does not remember the old country doctor who often left a few dollars next to his prescription. The doctors listened to the patient and their families and they often smiled at each other. They were generally respected, trusted, and loved. Nobody ever heard of suing the doctor and the insurance was not a major issue. Now everybody is covered by insurance (or else!). The doctor is secluded in his office, surrounded by assistants, submerged in paperwork and technicians, (who are) performing procedures and even "examinations." The first thing requested from the patient is not a list of his complaints, but to fill out forms concerning the type of their insurance, their SS number, etc. The P.E. (physical exam) is minimal, technicians and technology replaced the Hippocratic methods. Errors are more frequent than when the practice was more personalized and Malpractice--the big M--often caused by negligence, and sometimes by ignorance is more prevalent. Accidents and human error always existed, but we used to remember the saying "Errare humanum est." Now we think more in terms of suits than philosophical concepts. A special chapter should be dedicated to the Medical Business proper, directed by the owners of HMO's, Hospitals, etc., limiting the physician's humanistic role and his income, but not his responsibility. And let's face it, in spite of technicians and technology; in spite of the so-called Medical Business, Doctors are still needed. Who else could sign your death certificate?

-- Ana R. Marrero, M.D. 1913-1999

Thank you for reading.