Chapter XI: What Is Happening to Physicians' Manners and Morals?

Article excerpt

A Gothic Tale From The X-Ray Conference Room. When I left Poland in 1968, I first settled in Nakskov, on Denmark's southernmost island. I was appointed deputy head of Nakskov Hospital's department of internal medicine. This was a large department of more than seventy beds. The working day used to start at 8:30 with an X-ray conference at which the radiologist commented on our patients' roentgenograms. Sometimes the X-rays revealed a cancer--mostly of the stomach, or the lung, or the colon. Every time this happened, which was once a week or once a fortnight, all the doctors present, the head of internal medicine Dr. S, the four residents, and the radiologist burst into Homeric laughter. My sitting there, stone-faced, never spoiled the general hilarity. If the cancer had not been suspected by the internists, the uproar would not abate for a whole minute, at least.

I felt I had to find answers to nagging questions. How could adult men, doctors, behave in such a bizarre, obscene way? Who were these people? And who were we, men and women of my own circle? What made us what we were? Thus began the quest which I have pursued for more than thirty years.

What's Happening To Doctors' Manners And Morals? More strange observations followed. In 1971, a public debate was going on in Denmark whether to close or maintain the "unplanned" kidney dialysis center at a hospital in the town of Fredericia, on the country's central island of Fyn. The "abolitionist" party was led by the chairman of the Ministry of Health's committee on kidney disease, Dr. T-H, professor of internal medicine at Copenhagen's Rigshospitalet. Trying to discredit the leader of a Citizens' Action Group, this doctor called a press conference, announced that he was that man's attending physician, and divulged information from the patient's hospital file. The good doctor also mailed excerpts from the medical file to the editors of major Danish newspapers.

In Nakskov, I once told Dr. S, the head of the department that I applied for a position at the department of cardiology in Aalborg, a larger city in the North, and would go for an interview. This was unpleasant news to S, who was known as a difficult man and wouldn't easily find another deputy. On the day of my trip, S, quoting a formal, but never followed, point in my contract, kept me in the hospital past the hour of my train. I had to drive in heavy snowstorm, on slippery roads. I sighed, lamenting the professional circle I had left in my native Poland, the proud men who would never debase themselves by such petty bullying. I became uncomfortably aware that I had now fallen into bad company.

In Holland I was struck dumb seeing for the first time in my life doctors who intentionally caused deaths of their patients. Some of these acts involved low cheating. I discuss the subject elsewhere in this work; but let's turn again to lighter subjects.

In Den Bosch, a cardiologist, let's call him Dr. X, was asked to give out a patient's coronary angiography film for a second opinion. He refused. His pronouncement that the patient was inoperable was final, and as the owner of the angiography film Dr. X decided not to give it out. But the patient, a Mr. T, a half-Javanese former regular in the Dutch Army, was not a man who would easily give up. He called the press. An article in the province's major newspaper told the whole story and depicted Dr. X as a stupid bully. Only then did he agree to release the film. A second opinion was obtained: Mr. T's coronary arteries were slender and, indeed, a bypass could not be done by just any heart surgeon--but it could be done by one particularly skilled in operating on thin vessels. Mr. T had his coronary bypass done with good results by Dr. Cooley at St. Luke's Hospital in Houston, Texas.

The group of five cardiologists, of which Dr. X was a member, was also involved in another scandal. For reasons of economy, the Dutch Ministry of Health had authorized for the city of Den Bosch only one laboratory of cardiac catheterization. …