Reflections on Fifty Years in Medicine

John A. Rumsfeld, M.D.

John Rumsfeld was born in Oak Park, Illinois. He received his premedical education at Carleton College in Northfield, Minnesota. Following graduation he received internship/residency training in Internal Medicine at Parkland Hospital in Dallas, Texas, and, after two years as medical officer in the U.S. Army, he completed his training on the Columbia Division of Internal Medicine and Chest Diseases at Bellevue Hospital, New York City and Stanford University Hospital, California, followed by a Fellowship in Pulmonary Diseases at the Hospital of the University of California at San Francisco. His subsequent medical career has been as Internist and Pulmonary Disease specialist, first in San Jose and later in Newport Beach, with an intervening period as Medical Director of La Vina Hospital in Altadena, all in California. In retirement, his reflections emphasize his conviction of the importance of active involvement by the patient in his own care, particularly with self-education about his illness. As a patient himself, he also reflects on the patient-doctor relationship from the patient's point of view.

The excellent "Biopsychosocial" training in our relationships with patients which we received at Rochester from Drs. John Romano and George Engel was unique and valuable. This became increasingly obvious in our later practice. Several other classmates have discussed this aspect of our training in their essays. The current caring attitude of my classmates towards one another is a reflection of that training, and it continues to impress me.

We were fortunate to have practiced at a time when physicians were trusted and were able to practice without interference from third-party payers, the government, and hospital administrations. These forces have changed the doctor- patient relationship. The third-party payer system has placed emphasis on making money, which was not a part of our consideration when we committed ourselves to becoming doctors. The respect we enjoyed and hopefully earned diminished as it came under the influence of financial considerations.

During my third year at medical school, Dr. Franz Reichsman suggested that I obtain a summer Externship in the Department of Medicine at Parkland Hospital, Dallas, where Dr. Donald Seldin was Chairman. Dr. Reichsman said it would be an experience I would never forget because Dr. Seldin was the most outstanding teacher of medicine he had ever encountered. With Dr. Reichsman’s help I did just that, and a whole new and exciting world of medicine was opened to me. This set the stage for my straight medical internship in Dallas. The two years I spent there were easily the best years of my medical training.

I was drafted in 1956 and spent two years at the Army Chemical Center in Maryland (a waste of time). In 1968 I resumed my training on the Columbia Division of Bellevue Hospital and the Bellevue Chest Division. After this I moved to California where I intended to practice. I took a third year residency in Internal Medicine at Stanford and finished with a fellowship in chest diseases at the Hospital of the University of California at San Francisco. I considered accepting an offer to stay on the faculty there, but felt that my purpose in becoming a physician was to practice medicine rather than to teach it.

In 1970, after having practiced in a large group as internist/pulmonologist in San Jose, I accepted a position as medical director of La Vina Hospital, an 80-bed tuberculosis hospital in Altadena, California, an affiliate of the University of Southern California. This was of interest because the hospital was in the process of becoming a pulmonary disease referral hospital, and its affiliation with USC gave me an opportunity to strengthen and broaden my pulmonary medicine expertise. La Vina Hospital's endowment enabled us to accept all qualified patients regardless of their ability to pay. For the next five years I was able to recruit a staff of well-qualified chest physicians. We enjoyed an active in-hospital referral practice, implementing what was then a new concept called “pulmonary rehabilitation”. It was here that we developed the idea of having the patient be a part of his medical “team”, incorporating the Romano/Engel approach. Regular educational sessions explaining the nature of chronic lung disease and its treatment were a part of this team approach. These were my most gratifying years. The enhanced rapport with patients in this type of practice became a model for me for the remainder of my career.

Unfortunately, staffing and economic pressures affected La Vina’s ability to survive. I resigned in 1975 and moved to Newport Beach, California, to enter private pulmonary practice. I was asked to set up a pulmonary rehabilitation program at Hoag Hospital in Newport Beach, where I served as the program director initially, then continued to maintain an active role until I retired. Once again I realized the advantages of involving the patient as an informed team member in his own care, with emphasis on patient education. Even though these were extremely busy times they were rewarding. Newport Beach proved to be an interesting place to practice. My patients included John Wayne, Buddy Ebsen, Andy Devine and Arnold Beckman.

Now in my retirement years I have become aware of erosion in patient-doctor relations. I have had a progressive series of illnesses requiring spending a lot of time in waiting rooms for very short doctor visits. Since these are mostly selected doctors whom I previously knew, they remain friendly encounters, but I sense that there is a lack of intensity in their search for answers to medical problems. Times have changed. I wish I could share classmate Deane Hutchins’ prospect of an eventual return to the patient-doctor relationship we once knew. I believe that those days are gone forever. I feel so fortunate that we were a part of the “golden age” of medicine.