“At the beginning and at the end, there is the patient and the physician.”
Dr. Bernard Shapiro ’52, president of Shapiro Solutions, Inc., began his Sept. 23 lecture on the history, current state, and future of medicine with this quote. These words by Shapiro’s clinical professor at NYU School of Medicine changed the way he practiced medicine.
Shapiro described that becoming an excellent physician requires rational thinking and an understanding of medicine’s “noble ancestry and oath.”
Past: The History of Medicine
Humanity has practiced and developed medicine for over 4,000 years, and its oath of responsibility, Primum non nocere, is “First, do no harm.”
The first record of a rational treatment of disease comes from Egypt, where in 2500 B.C., a physician divided the process into four parts: symptoms, signs, diagnosis and treatment. This was the beginning of the doctor-patient relationship, and its values are still upheld by physicians today.
The Greeks in 1500 B.C. honored many gods, including Apollo, who became influential in the field of medicine. His staff became part of the caduceus, a symbol of medicine.
In an 180-bed medical amphitheater that served as one of Greece’s first hospitals, Apollo’s priests and priestesses provided each patient with individual care, giving them wine, bathing them in water and clothing them in white garments. These physicians even performed lifesaving surgeries using partial sedatives, like opium and belladonna.
This hospital became a model throughout the Western world, and its healthcare practices continued for almost a thousand years into the Renaissance.
American medicine began in the 18th century, when after the Revolutionary War, many injured men needed aid but could not afford it. The Continental Congress of 1776 funded veteran care - the first instance of government responsibility for Americans’ healthcare.
In the 19th century, nitrous oxide, ether, chloroform and most importantly, anesthesia, entered mainstream medicine. Florence Nightingale and Clara Barton reduced death from 50 percent to just 3 percent; Lt. William Crawford Gorgas ended the malaria and typhoid epidemics in Cuba and Panama; and John Hopkins developed his model of medical education: education, research and bedside treatment.
During the 20th century, Alexander Fleming discovered penicillin, and important technologies developed, like computer tomography (CT) scans and transplant surgery.
Present: Genetics in Personalized Medicine
In the past decade, the study of genomics has allowed for better understanding of organisms and their biological functions. The 21st century will give rise to personalized medicine specific to the individual, rather than the illness.
Future: Changing Policy and Relationships
The biggest change in medicine will come with the reconstruction of the health care system. Many speculate about the impact of the Health Care Act, which Shapiro pointed out could bring decreased salaries to the field.
With the raising cost of medical school, Shapiro predicted that most physicians, burdened with student loans, will choose to specialize rather than go into primary care. As the number of primary care physicians decrease, the long lasting tradition of the doctor-patient relationship may suffer.
Shapiro, who has served his community for 38 years as a family physician, advocated for the significance of primary care physicians. He said that an essential way of fostering the doctor-patient relationship is by being a rational thinker - one who truly understands the patient.
“Rational thinking constitutes the who, what, where, when, why and how of every medical problem that a doctor must ask and understand,” he said. “Listen to the patient; it will tell you the diagnosis. I’ve seen too many times when 17 seconds into the patient story, the doctor interrupts and proceeds to give his diagnosis. It’s because of quick, not thoroughly thought out assessments like these that mistakes are made and wrong conclusions are drawn to.”
Shapiro revisited the opening quote at the end of his lecture to suggest how the field of medicine might develop.
“The truth behind that quote from Dr. Samuel Standard that I gave you in the beginning of this lecture, concerning the doctor-patient relationship, may alter in the future because as unfortunate as it is, the physician may not always be a part of the equation."