Drug therapy was mostly quackery back then. Since, research breakthroughs have turned medicinals into rational, safe, and dose-specific therapies. Bearing veritable nanoscalpels in the form of drugs that zero in on a disease pathway invisible to the eye or even the microscope, internists rose alongside surgeons as healers. Much of the diagnostic work was turned over to newer specialties. For example, CT scans and MRI s give physicians the X-ray vision to peer inside a troubled body; and sonograms turn the noises of the stethoscope into images of a beating heart or a growing fetus. Diagnosis got better and much easier on the patient--but high-tech and expensive. This pattern has been replicated in virtually every domain of medicine. At the same time, the general field of nursing spawned nurse practitioners, allied health therapists, and physician assistants to complement medical expertise in the vastly more complex care of both the healthy and the sick.
Through necessity and opportunity, medicine has become a huge group effort. The titans of yesterday fought hard for their autonomy and happily polished their individual pedestals of near godliness. Yet, the wisest of them set the stage for their own toppling by embracing the endless frontier of medical science, which ultimately transformed the way we give care. But, solo or group, yesterday or today, on the frontier or in the midst of today's fast-paced clinic, the practice of medicine by all its participants has never been easy. It comes with long and continued study, hard physical and mental work, and heavy responsibility. Plus, it demands a piece of one's soul. Future doctors, nurses, and other health specialists always have been chosen not just for their smarts but also for their humanitarian values. They must be kind, merciful, and sympathetic to those they care for, whether the patient is old or young, rich or poor, appreciative or ornery.
Money is not an unimportant issue in the practice of modern medicine. Professional ethics dictate that payment must be secondary to the first interest of doing what's right for patients. Yet mercy and money have always been a tricky combination. In his famous almanac, Ben Franklin had a few gibes for doctors of his day: "God heals and the doctor takes fees." That hint of resentment came at a time when doctors were close to beggars and medicine a trivial part of the nation's economy. Today, the medical professions surely help the good Lord out, but the financial cost is mighty. Healthcare consumes 1 out of every 7 dollars of our national economy, and, as policy wags note, most of it is driven by the physician's pen.
There is an old saying that a physician is one upon whom we set our hopes when ill--and our dogs when well. That's easy to do, since at any one time most people are well and there's a certain suspicion about hefty resources being consumed by the ill. The steady, four-decade rise in health insurance costs, both government and private, has made modern healthcare possible. But at the same time it has introduced a new and less solicitous interest in between doctor and patient--that anonymous, often heavy-handed "third-party payer" holding most of the dollars.