Class of '54 Alumni Reflections

The Hourglass Project

Physicians’ Reflections on Fifty Years of Patient Care: 1954-2004

Introduction

For our 50th anniversary of graduation from the University of Rochester School of Medicine and Dentistry, each member of the Medical School Class of 1954 was asked to describe in a brief essay how the momentous changes in health care during the past fifty years personally affected his or her relationships with patients and patient care.

The result is a collection of thirty essays from physician classmates with careers ranging from direct patient care to public health, medical research and academic medicine. Included are essays from the widows of three classmates. The essays reflect the experiences from these diverse backgrounds, but the preservation of patient-physician relationships was the implicit concern of all. We called this the "Hourglass Project" because, like grains of sand pouring through the narrow waist of an hourglass, we came together in 1950 from a wide range of backgrounds for four years in medical school, then dispersed once more into a wide range of professional careers and locations.

The narratives make interesting, often lively, reading as, for example Bushey's, McCarthy's and Meyer's experiences in solo private practice. Hutchins' essay succinctly summarizes the changes that have occurred. Farley's presents the panoply of changes that occurred and shaped his experience decade by decade. Gangarosa's shows how chance events can shape a physician's career. Hare, Henderson and Kluge address some of the current problems and offer possible solutions. Finally, others such as Friedman's, Nadig's and Wright's essays are direct and poignant expressions of their personal experiences with patient-doctor relationships. We hope that you will enjoy reading them and that you will find them to be a useful commentary on medical care during the latter half of the twentieth century.

A few comments about our Class of 1954. It has two notable qualities. First, like our peers in other medical schools matriculating in 1950, over half of our classmates had served in the Armed Forces during or shortly after World War II. As a consequence, competition for admission to medical schools was especially keen; those who were admitted were highly able and motivated, sharing a common zeal to study medicine. We recognized these qualities in one another and respected one another because of them. Each felt privileged to have been admitted to medical school, and the atmosphere at Rochester promoted a strong sense of our being a tightly knit community of scholars with a common goal. Spouses of our married classmates fully shared in our sense of community. Second, as a result of our close associations, we have retained unusually cohesive relationships over the years following graduation. Evidence of this is our holding several off-year "mini-reunions", our united Class effort to create an endowed student scholarship fund that achieved our one million dollar goal by our 50th reunion in 2004, and the Hourglass Project itself.

Finally, the reader of these essays will frequently encounter the names of three faculty members who strongly influenced our careers. The first, Dr. George H. Whipple, Nobel Laureate and first Dean of the medical school, interviewed each of us when we applied to medical school. Later during his course in Pathology he again engaged each of us individually in front of our classmates in probing two-way "discussions" of our weekly assignments. Widely respected by students and faculty as the father figure of the Medical Center, his wisdom and laconic style commanded awesome respect from each of us. The second was Dr. John Romano, first Professor and Chairman of the Department of Psychiatry. A man of commanding intellect, he, during Saturday morning discussions with our Class in our first year, skillfully broke down our prejudices and preconceived notions about Psychiatry through wide-ranging discussions of contemporary social and cultural topics. This paved the way in the second year for the third major figure, Dr. George L. Engel, Professor of Medicine and Psychiatry. Dr. Engel was an internist and psychiatrist who, by skillfully interviewing patients before the assembled Class and at the bedside, revealed the emotional components of illness. He showed us how to uncover these during patient interviews and bade us to consider them in managing the patient's illness. He later articulated his views in his formulation of the "Biopsychosocial" model of medical practice that became the hallmark of the University of Rochester School of Medicine and Dentistry and strongly influenced American medical and nursing education.

Acknowledgements

We thank the Department of Academic Development of the University for sponsoring the Hourglass Project. Grateful thanks go to Nana Henderson, wife of classmate Donald A. Henderson and to my wife, Patience C. Hoskins, for their valuable copyediting. Thanks also to classmates Chloe Alexson, Joseph Flatley, Donald Hare, David Kluge and Neal McNabb for providing valuable suggestions and criticism. We appreciate the friendly cooperation and enthusiasm of Karen Gaffney, Brenda DeWind, and Kelly S.G. Johnson of the Office of Development and Alumni Relations for facilitating this project.

Lansing C. Hoskins, M.D., Editor

Dec. 12, 2006

Essays

These files are in Portable Document Format (PDF). You will need Adobe Acrobat Reader to open them.

Chloe G. Alexson, M.D.
"Where Has the Fun Gone?"

Harold L. Brodell, M.D.
"Post-retirement reflections"

Joae Graham Brooks, M.D.
"The Greatest Reward Was When I Wasn't Needed Any More"

Harold L. Bushey, M.D.
"Medical Changes in Fifty Years of Practice"

Eugene S. Farley, M.D.
"Fifty Years Since Graduation: Memories and Realities"

F. Joseph Flatley, M.D.
"Under Managed Care We Cannot Now, Nor Ever Will, Approach the Quality of Care We Were Taught to Deliver"

Helene Friedman, R.D. (Widow of Bernard Friedman, M.D.)
"Medicine is Intrinsically a Very Personal Business"

Eugene J. Gangarosa, M.D.
"A Different Medical Pathway"

Donald Hare, M.D.
"The Only Solution I Can See is to Return Health Care Decisions to Informed Consumers and Cost-Conscious Physicians"

Donald A. Henderson, M.D.
"Incidental Reflections Based on a Career in Public Health and Public Health Policy"

Lansing C. Hoskins, M.D.
"Pardon Me, Doctor, But Can You Spare a Few Minutes?"

Donald B. Hunton, M.D.
"There is No Question But That This Message – Listen to What the Patient Tells You – Is the Most Important Thing I Carried Away From Our Medical School"

Deane Hutchins, M.D.
"A Half-Century Reflection on the Practice of Medicine"

David N. Kluge, M.D.
"Challenge to the Medical Profession"

Muriel Kowlessar M.D. (Widow of Dhod Kowlessar, M.D.)
"These Are Truly Tumultuous Times in Medicine for Both Patients and Physicians"

Arthur E. Lindner, M.D.
"If Physicians Are Honest, Forthcoming and Have a Sense of Humor, I Doubt That the Patient-Doctor Relationship is Endangered At All"

James B. MacWhinney, M.D.
"A Physician Who is Accessible, Attentive and Respectful Will Form a Relationship That Withstands the Influence of Change"

Lloyd A. McCarthy, M.D.
"Reminiscences and Reflections"

Neal A. McNabb, M.D.
"As Primary Physicians We Were Only Interested in Patient Care"

Howard J. Meyer, M.D.
"The Doctor-Patient Relationship of Listening, Caring, Compassion and Advocacy Developed as the Result of Spending Time With the Patient and His Family Without Expectation of Remuneration"

Rowena Nadig, R.N. (Widow of Perry Nadig, M.D.)
"Perry and I Used to Say That We Had Spent Our Adult Lives Caring for Others, But Now That We Needed Care it Was Not What We Expected."

John Peachey, M.D.
"I Shall Ever Be Grateful"

Robert M. Rene, M.D.
"So Now We Have 'Bodies'"

H. Norman Richardson, M.D.
"Prepaid, Nonprofit, Comprehensive, Nationwide, Healthcare Organizations Are the Future"

John A. Rumsfeld, M.D.
"Reflections on Fifty Years in Medicine"

Paul O. Simenstad, M.D.
"What is in the Future for the New Physicians?"

Otto F. Smith, M.D.
"The Sands of Time Have Changed the Dunes of Medicine"

Dirk J. Spruyt, M.D.
"The Public's Health is Increasingly Being Undermined by Shortsightedness, Greed, and Environmental Destruction"

Robert F. Willkens, M.D.
"Every Time I Start This I Sound Like Some Old Guy Lamenting the Loss of the Good Old Days"

Robert G. Wright, M.D.
"A Tale of Two Doctor – Patient Relationships"