samedi 26 mai 2018


I have finished my usual monthly rotation with some of the medically underserved communities in the United States. The western medicine practiced here is far from the ideal vision of a patient centred care, in which his social, cultural, economic characteristics are taken into account.
Many of the so-called Family Practice offices that use more and more people with different educational formation (a Nurse can now easily become a Primary Care Provider after a short two year course, or any body with a degree can become a Physician’s Assistant with just two years of further training, and these people function as Primary Care Providers).
What is being done is Urgent Care, much like a dispensary where you go when you have minor cuts and bruises and coughs and colds. This kind of “slash and burn” mentality looks for a fast fix to relieve, but it does not work well when people are really ill
This non holistic urgent care mentality has spread among the doctors and even some specialists where they look for the quickest solution to the problem at hand, which usually involves action over words, medications over counseling.
I am fortunate to work with American Indians. With the Omaha tribe of Nebraska I have built a special relationship and have benefited enormously from their wisdom.
I fondly remembered Jim BB who was one of my earliest patients when we began the concept of Health Promotion and Disease Prevention (a crude form of holistic medicine practiced under difficult economic conditions). He used to say to me:
Only a Good Person can become a Good Doctor. He said he couldn’t understand when he heard the white doctors /providers bragged that they want to be good doctors. He would say: You cannot become a good doctor;  for that you have to be a good person.

I have been lucky to have the wisdom of Pierre M also of the same tribe. He had said: the doctors must realize that to provide better care they have to improve themselves and their humanistic side.

I was reading a touching story of Medical Humanities in the April 2018 issue of American Journal of Medicine, about the tragic death of the Jewish doctor Dr. Ismar Boas who was considered to be the pioneering founder of Gastroenterology. Having forced to flee his practice in Berlin by the Nazis, he left for Vienna. Dr. Boas’ mentor was Professor Hermann Nothnagel, a German Internist who in 1882 had become a Professor of Medicine in Vienna.

The following words were attributed to Professor Nothnagel:
Only a good man can be good physician.
Photo of Professor Nothnagel 

The voice of Jim BB of the Omaha Nation resounded in my ears. How a humble man like him had the level of wisdom of such intensity and universality!
Concluding the short article on Medical Humanities in the April 2018 issue of the American Journal of Medicine, the authors Hoenig and Thom write, I quote: (they were referring to a monodrama about the life of Dr. Boas)
It is noteworthy that looming over this drama is the image of Hermann Nothnagel with his inspiring words “Only a good man can be a good physician”. This maxim, timeless in its wisdom, can serve all physicians as a moral guide to help overcome any obstacle, whether economic, regulatory or bureaucratic that challenges our ability to give patients our finest medical care.

Sadly, that finest medical care is translated in the primary care facilities in this country as more medications, more laboratory tests and more interventions. They have either not been taught or nor heard of the Oslerian concept:  as a physician, you are half the cure.

It is a Friday Night here in the Omaha Indian Reservation and the shabbat candles are still lit.
I will say Kaddish (the jewish prayer for the Dead) for the Jewish Doctor, Dr. Ismar Boas 91858-1938) who was the founder of Gasteroenterology.

I have worked with some of the best Nurse Educators in the Indian Country, two of them stand out: Michele S and Ashleen BB, both at the Omaha Tribe.