Wednesday, October 29, 2008

Hubris in medicine

Dr. Peter Goodwin, OHSU Oral History Program interviewee number 104, has recently returned his edited transcript for final processing. Rereading the record of the session, I was struck anew by Goodwin's self-deprecating manner and the display of humility, hard-earned through long experience in both South Africa and the United States. Take, for example, these comments on hubris in medicine:
GOODWIN: In retrospect. Okay. In retrospect, medical school and a year and a half of internship: I think my overwhelming impression was one of hubris, which was transmitted to me. A lot of it was ignorance, a lot of it was really bad education. Some of it was good education. We had two professors of medicine who were good. We had a couple of professors of surgery who were abominable. OB/GYN was passable.

We had an excellent experience delivering babies at home as part of the OB rotation. Which was a most interesting experience. Because these were poor people, almost all of them colored, in their homes, in an area of Cape Town that was called District Six. Which was quite a hazardous area. A lot of crime, because it was very poor. But we were immune from that. We were recognized as, you know, succoring the poor, doing good. So we were never interfered with. And it was a very interesting experience.

But so much of it was so, you know, sort of, with such a level of certainty that you sort of left medical school with the feeling that you knew it all. And in fact, when you saw very little going into a rural environment. I knew nothing about, nothing worthwhile about psychiatry or psychology. I had been taught nothing worthwhile about public health, which was crucial in the environment that I went to.

And so it took, when I look back on that experience of this great young doctor, and I think about the errors that I made. And the errors not in a, not just in an individual sense, in a social sense. I was so busy giving black kids fluid, you know, sort of to help their gastroenteritis. And I never thought about why they were getting so much gastroenteritis. You know, a lot of them died as a complication of measles, but there was no immunization against measles at the time. And so the public health issues, I ignored. I was too busy being a hero.
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SIMEK: In your rural practices, among the poor and the undereducated, did superstition play a role in medical care?

GOODWIN: Hugely. Hugely. And again, Matt, I tell you, I am so ashamed of myself for my reaction to that sort of alternative healthcare. I mean, I used to mock it. I used to mock.

SIMEK: What was it? What did it consist–

GOODWIN: Well, it mostly consisted of witch doctoring. So there were these folk healers who probably had more psychological knowledge than I did. But for example, I can remember, again, I can remember several examples of my hubris. Woman comes in, she’s got congestive heart, she’s in severe congestive cardiac failure. So I see all the marks that, and the witch doctor accompanied her. And because, they’re so fascinating. Anyway, I’ll tell you—never mind. But I will tell you why. Because her husband had sheep, he has more sheep, flock of sheep, on the location. So they had come in from the location and the witch doctor accompanying them. The price of wool had just escalated tremendously to I think it was up to 200 pence a pound. And this guy’s wool had become valuable. And I kid you not, we used to charge them ten shillings for all hospital admission and treatment. So it was just a single fee of ten shillings. Often we didn’t charge them.

So I charge this woman ten shillings. I kid you not, her husband pulled out a roll of notes that were about that thick. [laughs] It was really amazing. And of course, that was why the witch doctor probably came with him.

But that was it, you know. I looked at these cuts that he had made, these ritual cuts. Idiot.

SIMEK: And?

GOODWIN: Well, she went into hospital. She turned out to be, if I remember rightly, I may be making this up. But it turned out that she was incredibly anemic because she’d had severe menstrual bleeding. And we, I can’t remember, I mean rarely, we rarely gave patients blood because we had no facilities to do so. And if there was a real emergency, we would get, we had, probably twenty people who would volunteer to come in if we needed blood urgently. And it was almost, it was very rare. Perhaps three times in the time that I was in Queenstown, this rural town that I practiced in.
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