STORY BYIf you can remember the first neighbor to get color TV, if you owned an Original Barbie, or saw the Wizard of Oz in the theater, then you likely remember getting sick and having the doctor come visit you.
Those were the days when doctors diagnosed through observation, human touch, conversation and thorough history-taking. “Since then,” says Herb Fred, MD, “high-tech has replaced high-touch.”
Author of his third book of collected essays, “Looking Back, Reflections of an Old Fashioned Doctor” (Mercer University Press), Fred is a professor of internal medicine at the University of Texas Medical School at Houston and is known by his medical students and house officers for often sitting on the edge of patients’ beds and holding their hands. “I am, first and foremost, a patient advocate,” Fred says.
This old-fashioned doctor of 74 even dedicates his book “In loving memory of bedside medicine.”
Fred, recipient of the 1999 Benjy F. Brooks Outstanding Clinical Faculty Award and who also has a medical society named in his honor, has spent 50 years teaching doctors to place patients above and before the pathology they present. And he has spent the last 30 years teaching doctors to balance technology with attentiveness.
For Fred, there is no “gallbladder in room 302, there’s a woman in room 302 in a lot of pain from her gallbladder.” When he arrives in the mornings to make rounds at the hospital, he might be greeted with, “Sorry, Sir, there are no interesting patients today.” His response is that all patients are “interesting,” but not all doctors are interested.
Fred fears that the explosion of medical technological advances may have supplanted “the art of medicine, that of listening to the patient, thinking about what the patient said, and relying on our own skills and good sense to diagnose.”
High-tech also may have critically injured the most valuable resource a doctor has: the patient-doctor relationship. “Technology has replaced the human element,” Fred says.
Fred believes that the shift from “touch to tech” occurred in the mid-70s with the advent of the CT-scan and other advances in imaging. “Before the CT-scan, we’d take a good medical history, and do a careful physical exam. Then we’d think about what we had and research and worry and think some more.” Most importantly, doctors saw the patients, themselves, as their best source of information.
“Now, in one fell swoop, we have bypassed the history and the physical and gone straight to the test. And the image does not tell the whole story.”
Fortunately, Fred, who says he is one of the “last of a
vanishing breed” has impacted young physicians who wish to
nurture the compassion of medicine that Fred’s generation
feels is missing.
Borrowing techniques from the theater, the medical school has a
special visiting professor who joins the faculty each spring to
teach doctors the “art and craft” of listening.
Megan Cole is an award-winning actress who originated the role of the dying cancer patient whose emotional transformation occurs through exchanges with her doctors in the Broadway hit, “Wit.”
One night, after a show in Houston, a group of doctors and cancer patients stayed for a discussion. Cole says she discovered that both groups craved a closer, more compassionate relationship but often didn’t know how to reach out to one another.“ I was so moved by the issues that both groups voiced. I realized that my role in ‘Wit’ might have an even higher purpose, that I could use my acting skills to truly help others,” Cole remembers. Now, in her third year as a medical school “visiting professor,” Cole routinely teaches body language, listening skills, and “empathy” to young physicians.
Cole does not blame the professionals as much as the nature of the profession. And she readily adds that "It's a two-way street here. Patients must learn how to explain themselves, their symptoms, so that they can be helped."
Fred agrees that patients need to speak up to their doctors if they have complaints and he is often stumped by their silence. Patients will complain to him or to their friends that they feel misunderstood, dismissed, or intimidated by their doctors, but Fred says they will not confront their own physicians with these feelings.
“You have the right to complain. You are paying for this service and you should complain at the time of the service. For whatever reason, patients are afraid to challenge their doctors, to ask questions, to get second opinions. You must take responsibility for your part of this relationship,” Fred says.
The communication breakdown seems to occur on both sides of the sick bed. The doctors are frustrated that their patients don’t seem to listen to instructions. Then the physician is blamed for not having explained it well enough.
Chief among physician complaints is “that their patients are ‘non-compliant.’ But part of the reason is that the doctor never took the time to tell the patient what to do. Then he refers the patient to a clinic for more testing and the patient doesn’t show up. If he’d listened to the patient in the first place, he’d know that they had no means of getting to the clinic,” Fred explains.
Though medicine has changed drastically in the 45 years that Fred has been teaching, he still views it and teaches it as an art, more than a science. “I don’t see house calls making a comeback, but I sure miss them,” he says. “You gain a whole lot of information about your patient by stepping into his home, knowing his family, what stress he lives with. None of that shows up on a scan or lab report.”
Looking Back: Reflections of an Old-Fashioned Doctor is available on www.Amazon.com
Herb Fred Medical Society: www.herbfred.org
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Dr. Herb Fred is a professor of internal medicine at the UT Medical School.
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