Old-Fashioned Doctors
Hospital Practice
December 15, 1998
In the 40 years that I have been a full-time medical educator, much has changed regarding what we teach and how we teach our students and house officers. As a consequence, I now confine myself to teaching basic medical principles – principles that should never change. But even so, today’s trainees tell me that what I say and do is old-fashioned. I wonder:
• Is it because old-fashioned doctors spend whatever time it takes to obtain a good medical history and physical examination?
• Is it because old-fashioned doctors routinely seek all of the patient’s previous medical records, not just the discharge summaries?
• Is it because old-fashioned doctors do not order sophisticated, expensive studies when simpler and cheaper procedures can supply the needed information?
• Is it because old-fashioned doctors order tests to substantiate, not generate, their clinical impressions?
• Is it because old-fashioned doctors use their brain and their heart, not an army of consultants, to manage their patients?
• Is it because old-fashioned doctors view consultants as opinion givers, not decision makers?
• Is it because old-fashioned doctors treat patients, not numbers?
• Is it because old-fashioned doctors do not blindly administer a ton of drugs in an attempt to alleviate every possible ill?
• Is it because old-fashioned doctors recognized that doing nothing is, at times, doing a lot?
• Is it because old-fashioned doctors understand that patients often get well despite what we do, not as a result of what we do?
• Is it because old-fashioned doctors realize that good rapport with their patients is their best protection against lawsuits?
• Is it because old-fashioned doctors are aware of their own fallibility and are never afraid to say “I don’t know”?
If so, then I am proud to be old-fashioned. And I believe that if more doctors today practised medicine the old-fashioned way, our profession might regain some of the nobility and respect it once enjoyed.
Herbert L. Fred, M.D.
Herbert L. Fred is Professor, Department of Internal Medicine, University of Texas Health Science Center at Houston.