The Good Doctor: A Father, a Son, and the Evolution of Medical Ethics

Barron H. Lerner
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Along the way, I discuss how he exemplified the humanistic and paternalistic physician of this era, including taking on the emerging profession of bioethics, which was challenging his authority. I reached back to my own childhood in a secular Jewish home, and then described my education and training as both an internist and a historian of medicine. Among the issues I studied extensively as a historian was the evolution of bioethics.

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I largely rejected the paternalism of my father in favor of patient autonomy, while trying to practice my own brand of patient-centered medicine. Although my book is thus both biography and autobiography, my training in history was as a social historian. So I also sought to place the careers of my father and myself in their proper historical context and within the existing historical literature on clinical practice, medical ethics, and death and dying in the middle to late twentieth century.

Did I succeed? You can read the book and decide for yourselves. But what I did not do in the book was to spend a large amount of time exploring the historiographic implications of my effort. If so, does it suffer from some of the flaws noted by critics of this approach? Is it possible to merge biography and autobiography with social history, or does my personal involvement with the subject matter somehow jeopardize my historical scholarship? Finally, what does my book say about the long-standing debate between biographers and social historians? Are their approaches truly distinctive, or are they complementary ways to conduct satisfactory historical research?

So at the risk of exposing you to an hour or more than you would likely care to know about me and my family, I will forge ahead and try to answer some of these questions. Courtesy of Ronnie Lerner. That is, chronicling the lives of important historical figures was equated with telling the histories of the eras in which they had lived.

Things changed in the late nineteenth century with the emergence and professionalization of American historians. In some sense, the history of medicine did not conform to this historical change. For one thing, these new academic historians wrote political, labor, financial, and military history but not medical history.

As such, physicians—who were almost exclusively amateur historians—continued [End Page 57] to dominate the field with biographical works. In contrast to academic biographies of, say, political figures, these works tended to be largely hagiographic, chronicling the contributions of these great doctors to medical progress. Of note, beyond their efforts to document the historical record and praise their medical ancestors, physicians promoted the history of medicine for another, often forgotten, reason.

Learning about the history of medicine, they believed, was a way to humanize modern medicine, especially as its scientific and technological prowess was on a steep incline. Rejection of the history of medicine as a Whiggish success story of the medical profession did not only result from the revisionist works of social historians.

By the early s, several research scandals, such as Tuskegee and Willowbrook, had called into question the ethics of the medical profession. And certain women with breast cancer, misleadingly told by male surgeons that they had to get disfiguring radical mastectomies in order to survive, began a very public revolt. Health Care in America led to a series of celebrated interchanges between the old and new guard. As with many ideological arguments, this one remained highly polarized.

Among the adjectives Bernheim used to characterize Cushing were sarcastic, inconsiderate, impatient, ruthless, and domineering. He told a story of how Cushing once ripped up a paper he had written. But even more important, Bernheim described in fairly great detail admittedly uncritically the large amount of mortality that had accompanied the early pioneering neurosurgical operations developed by Cushing.

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Boston, MA. He died in , at He acquired vast clinical experience at the Haynes Memorial, an isolation hospital located near Boston, at which he saw many infectious diseases which were on the decline, such as diphtheria, scarlet fever and whooping cough. Springer Nature Switzerland AG. Paul, John Stenhouse and Hamish G. Then the media found out, and soon all of America knew.

Discussions of the perils of experimentation—and the ethical conflicts they engendered—would become a cornerstone of the new social history of medicine. Yet here was the topic in print in Similarly, a more recent work of great doctor history, the autobiographical Life of the Clinician by New York City gastroenterologist Michael Lepore, published posthumously in , also contained information that would have fit well in traditional social histories.

For example, Lepore offered a firsthand account of anti-Semitic and anti-Italian sentiments expressed at medical schools during the mid-twentieth century. Another parallel between social history and biography is their use of sources.

'Good Doctor' Puts Past Medical Practices Under An Ethical Microscope

One tends to think of social historians as mining archival sources such as the records of organizations, personal correspondence, and newspapers. But good social history also uses diaries, oral histories, and interviews that often recount the lives and opinions of specific historical figures.

Why should two different books that obtain their narratives from predominantly the same sources reflexively be seen as good history in one case and unacceptable history in the other? Finally, another way in which social history resembles great doctor history, it has been argued, is in its presentism. But it would be unfair to imply that the inclination of physician-historians to emphasize scientific progress is by definition flawed when social historians may have their own agendas. Recently, serious scholars have tried to move past the polarized discourse and really contemplate the value of great doctor history.

That is, these works can corroborate—or contradict—the more comprehensive social histories that detail events and draw conclusions about medical practice during the time periods in which their subjects lived and practiced. A good example of this phenomenon is provided by two biographical works by the historian of medicine Jacalyn Duffin. Although social historians of medical technology had cited Laennac as embodying the positivist spirit of nineteenth-century French medicine, Duffin revealed that her subject was [End Page 61] actually more of a vitalist than a materialist.

The idea behind social biography is to explore the social and cultural context within which the life of a physician—or another historical figure—unfolded. But it then calls into question the previously accepted version of Pasteur as the brilliant French scientist who had discovered the germ theory of disease and was thoroughly revered in both his native country and throughout the world.

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The book was thus not only a biography but an exploration of academic advancement, fraud, and memorialization. Groenevelt, who spent most of his medical career in England, actually had some renown due to a legal proceeding in which he was charged with malpractice for his use of cantharides Spanish Fly for urinary problems. Have all great doctor histories been about white men? Given that until recently, most physicians—and their physician-biographers—were white and male, most have been. But there have certainly been biographies of early women physicians, such as Elizabeth Blackwell and Marie Zakrzewska, 23 which use the hagiographic approach familiar to the narratives of great male physicians.

However, because the subjects of these works were women who composed a tiny minority of the profession, it was difficult for authors to write Whig histories that ignored issues—such as sexism—that permeated the experiences of these pioneers.

Dr. Park’s Heart-to-Heart with His Son – The Good Doctor

Moreover, once social historians began to study women physicians, it was only logical that issues of gender would come to the forefront. For example, as historian Regina Morantz-Sanchez showed in Sympathy and Science , many women physicians showed a particular affinity for the eugenics movement. And when historian Arleen Tuchman wrote her mostly laudatory version of the life of Marie Zakrzewska, she emphasized how her subject had a difficult personality and gave mixed messages about whether women practiced medicine differently than their male counterparts.

So, too, with the gradual increase of minorities in medicine in the late twentieth century, books began to appear that documented the stories of African American and other minority physicians. As with women physicians, the pioneering achievements of these doctors shared space with stories of how they faced frequent discrimination.

Recently, a young African American physician named Damon Tweedy has written an autobiography documenting his experiences in the largely white world of medicine. Scholars have made several claims. Most notable is that the study of individuals or groups of individuals captures what historian Arthur O. History is also about getting into their heads, so to speak. These types of arguments make sense for an important reason. Having said this, we should always be careful when asserting that we knew what people were thinking.

More obviously, biography, especially if written by students or colleagues, has another potential advantage: the author may have been present during the events that he or she is describing. This type of knowledge is a potential double-edged sword; memories of events, particularly those from many years before, are notoriously unreliable. Bernheim asserted to his readers that there was no doubt that Osler was being satirical, although press coverage at the time suggested otherwise.

My book on the careers of my father and myself demonstrates some of the advantages of biography. The portion focusing on my dad might be termed a microhistory of a consulting physician from the s to the s. My father obtained a modicum of fame early in his career, being the lead author of a four-part series on infective endocarditis in the prestigious New England Journal of Medicine. And he achieved great renown among his colleagues in infectious diseases and other fields in the Cleveland hospitals in which he practiced.

Not extraordinary, he was not likely to warrant a biography from someone other than his son. Yet, he was not ordinary either. This is not to say that my book upends the standard historical take on American medicine during the decades in question. And my father was an unabashed paternalist, which was the norm for physicians of this era. He felt entirely comfortable making decisions for patients, routinely keeping them in the dark and at times actively misleading them. My father also participated in a number of other activities that the fledgling profession of bioethics found objectionable and used to justify its existence beginning in the s.

For example, when he was an infectious diseases fellow, he and his colleagues performed research without consent at an institution for mentally disabled children. Nevertheless, such experiments were hardly risk-free and victimized an already vulnerable population. Similarly, my dad worked very closely with the pharmaceutical industry, particularly Eli Lilly, which funded his research as a fellow and a young professor. I vividly remember his bringing home various gifts that he had received from drug company representatives, presumably in exchange for promoting the use of their particular drugs.

In , Lilly gave him between five and ten thousand dollars for a trip to China in exchange for his mentioning Lilly agents in his lectures. Much ink has been spilled on the loss of humanism among physicians as medicine became more bureaucratic and specialized in the twentieth century. That is, the great diagnosticians and wise professors, beginning with William Osler and continuing with Soma Weiss, Paul Beeson, and [End Page 67] Edmund Pellegrino, have been replaced by physicians who are too reliant on technology and clinical guidelines.

My father routinely gave out our home phone number to patients and kept in almost constant contact with his house staff and infectious diseases fellows during our family vacations although he was careful to let them run the cases.

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My family was permitted to go on vacation only during the last two weeks of a month—once my dad would have had enough time to indoctrinate his new monthly team and make sure they knew the patients intensely. That meant that, in essence, he was on call every day and night for twenty years. Of course, it is not as if he got constant phone calls at night and on the weekends.

But he got called a lot, and he was always the one who dealt with the most complicated infections. In a small number of difficult cases, in which patients with chronic diseases developed a series of infections over many years, he became their de facto physician, intensely monitoring their care to keep them alive and in good health. This was the case with a number of the first HIV patients in Cleveland, whom he often visited at their homes when they were too weak to travel.

He also had seen Weinstein and other masters of the field practice their craft on complicated patients who did not fit cleanly into specific diagnostic categories or were not responding to the usual type of antibiotics.

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As a result, my father felt comfortable trying clinical maneuvers that did not exist in standard textbooks and even at times contradicted the results of randomized controlled trials. These interventions did not always work, but sometimes they did, and alleviated difficult problems.

The Good Doctor: A Father, a Son, and the Evolution of Medical Ethics by Barron H. Lerner

In contrast to the received history, perhaps, my dad and his colleagues were not blind to issues such as the misuse of technology and mismanagement of death and dying. Indeed, as an infectious diseases specialist, my father had a front row seat when it came to end-stage patients, often with dementia or cancer, and frequently from nursing homes, who were admitted and readmitted to the hospital with infection after infection that needed treatment.

After therapy was completed, these sad individuals returned to their poor quality of life, either no better or worse. In such instances, doctors rarely spoke to the patients or families about issues such as prognosis and palliation.