Kill As Few Patients As Possible

This is the title of a slim volume written in 1987 under a pseudonym, Oscar London, MD. I buy a few every so often to hand out to new, young doctors. I quote from it regularly, after all these years. The subtitle: "And 56 Other Essays on How to be the World's Best Doctor", gives a clue to its appeal. What young doctor wouldn't drool over the advice of an old fart giving advice after 30 years in practice and trying to be funny?

The first chapter "Be Jewish", was inadvertently the subject of a recent dinner-table conversation at my place. My Jewish identity is a complex and nuanced discussion for another time, but I can't help but recall that when my parents long-time internist and friend retired, and my parents were in a quandary, he strongly suggested that his son, a cardiologist who also did primary care, take over their care. (Suffice it to say his religious and cultural persuasion is relevant to this discussion!) When my parents hesitated...he was young, they remembered him as a somewhat neurotic child (but who wasn"t ?)... their doctor said: " You need a doctor who worries, and my son worries !". Do all Jewish doctors worry? Are there goyisha doctors who worry? These questions I don't have answers for. But If your doctor doesn't worry at least a little, look elsewhere...this is one of MY lessons, though this one is implicit in some of Oscar London's. But the worrying doctor better also be able to laugh.

I have patients who see their mission at each office visit to get me to laugh. They are usually successful. A great mystery of life is our capacity to laugh one moment and cry the next. This is what good primary care is. If there isnt BOTH going on EVERY DAY, then likely your doctor is struggling personally, or has a stick up his or her ... I keep in my office three hand colored old Italian lithographs, cartoons really, that I found in an upstairs closet at Doc Jo's estate sale (look for a "Doc Jo" post, or search out on your own: Josephine Evarts, MD) that were apparently considered in too poor taste for her waiting room so she took them down and stashed them. I persuaded the nice woman running the sale to sell them to me...really I would have paid almost any price, because they are the essence of her wry humor, which was legendary for its stark and somewhat dark nature; they depict medieval scenes of a poor soul getting limbs amputated and re-attached in the wrong way and another receiving a blood transfusion through a hose attached to a donkey's ass.

When Karen and I moved up here in '75 we went to Doc Jo about a breast lump Karen had discovered. Jo Evarts was in her mid 70s at the time, and had seen a few things in a very long, very busy career, but we couldn't be sure she was the real deal. She did a breast exam, paused for a second and said: "Well, we could cut it off and put it on a plate." We looked at each other and thought we might be in the presence of a mad woman; she chuckled a little and said, "you know, do a biopsy!"

And of course, we know that Norman Cousins who was incapacitated in a hospital bed in an exceptionally painful way (ankylosing spondylitis), cured himself and got up and walked out on his own steam after "the laughter cure": Chaplin, Laurel and Hardy and so on.

So, OF COURSE: Kill as few patients as possible, and find yourself a doctor who is willing to sign on to that credo and smile about it.

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