Medicine is Intrinsically a Very Personal Business

Helene Friedman, R.D.,

Widow of Bernard Friedman, M.D.
Bernard Friedman, a decorated combat veteran of World War II, was born in Elgin, IL and received his baccalaureate degree from the University of California at Los Angeles. Following graduation from the medical school, he interned at the University of California Hospital in San Francisco and did his residency and fellowship training in Internal Medicine at Strong Memorial and The Genesee Hospitals in Rochester, New York. Until retirement he practiced Internal Medicine in Rochester and was an Associate Attending Physician at Strong Memorial and Genesee Hospitals. Helene Friedman succinctly describes the changes in patient-doctor relationships her husband experienced during his career and in the last 24 hours of his life.

Please understand that my comments about the change in the physician-patient relationship are from a personal perspective, and I do not claim that they are objective or professional in any way. Although I was a hospital dietitian, I have not worked in the medical field since the birth of our first child almost 45 years ago. My association with the medical profession could be described as a largely symbiotic relationship. Bernie and I were married at the end of his second year in medical school and we spent the next 44 years together through his training, medical practice, and retirement.

Bernie loved his practice of Internal Medicine. He thoroughly enjoyed the challenges of diagnosis and treatment. He LISTENED to his patients; sometimes that was all they needed, but most of the time he could glean a symptom or suggestion leading to diagnosis and often resolution of the problem. Bernie was a very caring physician. His impatience and disenchantment came in later years when - with the invasive health care system - he lost control of the care of his patients to a large extent. The insurance companies decided if and how his patients would be hospitalized, and which tests were appropriate for reimbursement. He spent increasing amounts of his time arguing with third-party providers and filling out endless forms. The frustrations and stress outweighed the satisfaction and joy in his practice.

My own personal feelings of medical practice today have also been influenced by the treatment Bernie received at Strong Memorial Hospital for a scheduled surgery during his last 24 hours of life. While the nursing care was good, most of the resident staff seemed uncaring, rude and even insulting. At least they apparently did not consider Bernie a surgical risk or indeed a very challenging patient. His last night was spent without sedation because the resident doctor on duty was "too busy" to write the order. His own surgeon did not arrive on the scene until just before the operation the following morning. EKG's were taken and repeated with no explanation, leaving Bernie to wonder why. Why indeed! Bernie died of a massive heart attack during the surgery.

At the outset of this essay, I mentioned that my comments were personal and not intended to be an objective observation. But medicine is intrinsically a very personal business. Healing is personal, and it often must extend beyond the wound to the psyche, and even to the patient's loved ones. The way medicine was practiced on Bernie has created far more wounds than it has healed. And as both the science and business of medicine march to ever greater heights, the "art of medicine" withers and few will notice that in its path has been trampled a true and devoted healer.