“The life so short, the craft so long to learn.” ― Hippocrates
I always thought it a bit strange that doctors refer to themselves as ‘practicing’ medicine. In a smart-aleck moment years ago, I once told a doctor that I was a practicing patient with make-believe problems… so practice away! Once in a conspiratorial mood, I thought maybe ‘just practicing’ was dreamt up by the legal system as the perfect defense for a malpractice lawsuit. “Your honor, I tell all my patients that I am simply practicing. One cannot guarantee a particular outcome when all I am doing is practicing. We never actually play a real game. Because the patient didn’t ‘win,’ I cannot be held responsible.”
In my town is a medical school. They train mostly the young in the art of practicing medicine. Privileged to have been allowed a tour, including the room where they learn how to save lives, I pondered the life of the full-sized mannequin lying on the emergency bed to be cared for by the green and fearful. They are to save its life over and over, and if unsuccessful, they are to have learned from the experience. Practice makes perfect.
There was a day when a doctor held a special place in our lives- especially our primary physician. He or she would get to know you as they break all physical distant barriers in their need to plod and poke your most intimate regions. Depending on your symptoms, they sometimes must ask deeply personal questions regarding things like your toilet life and even your sex life. Much of their life is spent troubleshooting the complexities of patient health. That takes practice and an abundance of curiosity.
I, fortunately, have just such a relationship with my doctor. He’s old school, and he’s allowed me to get to know him, which is possibly his genius. He loves a little conversation. With a generous sense of humor, he might tell of a humorous encounter or carve off a joke in the course of our exchange or when slapping on a pair of latex gloves (a sound I hate). Perhaps medical school taught him the curative value of laughter in the treatment of our ailments. But I suspect it was instinctual for him.
My last appointment with my doctor was different. Still warm and generous, he was also a bit beaten down. He had a story to tell, but it wasn’t funny. He had gotten into trouble with a state agency that decides who is allowed to practice medicine and who isn’t. After some months of an investigation, the agency claimed his practice was in violation. He must now be punished or be run out of town.
My doctor is my age. He wants to practice medicine as long as I trust him to practice on me. He doesn’t want to be turned out to pasture and walk away from a lifetime of relationships. He built his clinic from scratch and feels a deep responsibility and bond with his associates, employees, and patients.
Knowing my doctor for years, he has never lied to me. I suspect, can nearly guarantee, he never lied to the investigators either. He told them straight up that the allegations were true but perfectly within his right to practice medicine. So what did he do that would put his entire medical career in peril?
At the height of the pandemic, when fear hid behind masks and the desperate pleaded for remedies, he prescribed Ivermectin to a patient suffering from COVID-19. She had come to see him quite sick and asked for a prescription for Ivermectin. He obliged. The patient responded quickly and fully recovered. To this day, she credits the good doctor with saving her life.
Maybe it helped her. Maybe not. The practice of medicine is an imprecise proposition. We don’t always know why one responds well to something and another not. Even placebos have been known to have their efficacy.
Unfortunately, in an unrelated medical emergency, the recovered Covid patient ended up in the emergency room at a local hospital. She was asked about her recent prescription drug history and included that she once had a prescription for Ivermectin to help her recover from Covid. For some reason, that bit of info triggered the emergency room attendant (not a doctor), and a call was placed to the state health agency’s ‘rat on an offender’ hotline.
This all happened when various drugs were consuming us with controversy. One study would contradict the next study, and everyone with a Twitter account was an expert. Polls were taken with one poll suggesting that over sixty percent of physicians would prescribe Ivermectin to a family member. But the research and studies were still inconclusive. So polarizing was this argument that if the president were to suggest a possible benefit, then half the country went nuts, convinced it was all part of a vast orange-hair political conspiracy to destroy democracy.
Having been swept up in what was no longer a serious scientific inquiry but rather a political controversy, some states saw an advantage and created new laws and simply banned the use of Ivermectin for the treatment of Covid. They sighted nebulous potential side effects and inconclusive studies, despite the National Institute of Health simply recommending against the use.
They invoke the do no harm pledge a physician makes before practicing medicine without ever blushing from the irony that most prescription drugs can potentially harm you with various side effects. Ask anyone who just endured a round of chemo. Using their own logic, all drugs, except placebos, should be made illegal and, perhaps, even them.
These same folks approve and support the giving of hormone blockers and other severe medications that prevent a confused adolescent from either becoming a fully formed male or female. But if a desperate, fearful, sick patient willing to try nearly anything asks for a drug with very few side effects, the good doctor is to be run out of town.
There is a substantial difference between ‘recommends against’ and making a drug illegal in certain applications. In fact, there are very few drugs a doctor is not allowed to prescribe in their effort to practice medicine. Making a drug illegal for a specific ailment breaks some new regulatory ground. Many doctors are finding it demeaning, if not outright dangerous causing far too many to leave the profession.
Having run afoul of a new, somewhat capricious, and politically inspired law, my doctor was to be punished. Under threat of losing his right to practice medicine, the health agency informed him of his punishment.
In a third-grade classroom sixty years ago, I vaguely remember committing an offense my teacher thought serious enough for punishment. She had me write an essay as to why I did what I did and why it was wrong. I was to lose playground privileges for a week. And I was to write a letter to my parents apologizing for my behavior (that was the hardest part). Naturally, I did not feel the crime fit the punishment, but I was in no position to ask for a judge and jury. I was looking at her.
In a similar, somewhat juvenile fashion, the state health agency required my doctor to pay a $5000.00 fine, write a 1000-word essay detailing what he learned from his indiscretion, and take three hours of continuing education on how to treat COVID-19. Once complied with, the threat to our community of losing another practicing doctor, one with decades of experience, goes away. I suppose we should be grateful.
The good doctor has complied. Despite encouragement to battle back from a wide swath of the healthcare and legal community, he’d rather care for his patients. The experience has taught him that faceless bureaucrats care little for what it actually means to practice medicine. When little is known, and all you have is the hope that a remedy might offer- is it not the best medicine?
Doctor’s Sonnet
A doctor is one who’s gentle as a bird,
A doctor is one who’s brave as a soldier,
A doctor is one who’s amusing as a clown,
A doctor is one who’s caring as a mother.
Treating the sick is not a comfort job,
It is a difficult life without leisure and lure.
If all you want are wealth and tranquility,
Trade in your medical license for a liquor store.
The world is filled with doctors most cold,
Many don’t practice medicine but self-centricity.
Instruments and intellect don’t make a doctor,
Without warmth all pills lose their efficacy.
Healthcare means aid first talk rules later.
Better a kindhearted fool than a heartless monster.
― Abhijit Naskar
