More about Primary Care in 1940

“Curmudge, what’s this more 1940 stuff? We talked about that last week. Didn’t you get it all out of your system?”

“Actually, Jaded Julie, I didn’t. I simply remembered more. My mind runs rather slowly in reverse.”

“Sure. About the same as your top forward speed. Okay, so what’s your story? Was everything better or worse back then?”

“Some of each, Julie. Remember my telling about our family doctor cutting out my ingrown toenail? Well, it got infected. It hurt like mad, and when Dr. Arnold took off the bandage, it looked ghastly. I was afraid we’d have to use gentian violet or whatever the purple stuff was that he used to treat my impetigo a couple years before. Instead, he sprinkled something called ‘sulfa powder’ on it, and it cleared right up. It was a miracle!”

“I bet it was. There were fewer antibacterial medications then; and because they were so new, the infection-causing bacteria had not yet developed resistance to them. It was good news in 1940, but now fighting many infections has become more difficult. So what else was going on then other than World War II in Europe and Jack Benny (who was that?) on the radio?”

“I recall Mrs. Arnold telling about traveling with her three children. They all became ill and needed medical attention. She told the physician that her husband was a doctor, and the physician felt obligated to treat the family without charge. It was called ‘professional courtesy,’ and then it was offered routinely. It is not as straightforward now because of legal (Stark anti-kickback laws) and insurance issues.”

“You are still making things sound pretty good in 1940, Curmudge. Other than the physicians’ limited armamentarium (see, Curmudge, I finally learned that word), there must have been some things that weren’t so great about primary care during your childhood.”

“When I was much younger, it was common for a person to become ill and die while under the care of just his primary care physician. Now in the U.S., except for extremely isolated locations, a seriously ill person is promptly referred to the appropriate specialist. The patient often studies his illness and becomes involved with more than a single caregiver in developing his plan of care.”

“I guess medical care was not always as transparent as it is now.”

“Right, Julie, and that could have been a problem in the past when medicine was often practiced in patient-one-doctor isolation. If your primary care physician had the knowledge and personality of a Marcus Welby, you experienced positive, personalized care. In the hypothetical case of a physician who was so confident of his abilities that he would not entertain discussion with anyone about alternate approaches or a second opinion, the patient would be at risk. That would certainly be the case when the physician made the statistically almost-inevitable error in diagnosis or treatment.”

“That sounds scary, Curmudge, especially when you consider that nobody is perfect.”

“The problem is compounded, Julie, when the patient as well as the physician carry the old-time image of the infallible doc. The patient says, ‘It’s okay if the doctor says so,’ and then abdicates all decisions to the physician.”

“So what do you do if the patient in this situation is your aged parent?”

“You intervene, if possible. But that’s a different story.”

“I have the feeling, Curmudge, that this is one of those very rare occasions when you know what you are talking about.”

“In this blog even the hypothetical cases are true. The only things fictional are you, Jaded Julie, and I, Kaizen Curmudgeon.”

Affinity’s Kaizen Curmudgeon