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Oral History Interview - Dr. Hugh Arnold (interview 4)

https://collections.galtmuseum.com/en/permalink/descriptions82110
Date Range
1994
Description Level
Fonds
Material Type
Recording
Accession No.
19931081171
Physical Description
1 audio cassette (digital file)
Scope and Content
The following transcript was prepared by Donna Kampen. A: You know, I want to get you that information I have, that interview I had up in Calgary. That covers a lot of this stuff. Q Well, if we haven't covered some things adequately, its because I haven't asked the right questions, I…
Material Type
Recording
Date Range
1994
Fonds
Dr. Hugh Arnold fonds
Description Level
Fonds
Physical Description
1 audio cassette (digital file)
Physical Condition
Excellent
History / Biographical
Dr. Arnold donated his papers to the Galt Museum and Archives in September 1993, with the provision that they be available for an independent study project done by University of Lethbridge student Donna Kampen, under the supervision of Professor Bill Baker of the Department of History. Donna Kampen organized Dr. Arnold's papers conducted a series of oral history interviews (8 audio cassettes) with Dr. Arnold.
Scope and Content
The following transcript was prepared by Donna Kampen. A: You know, I want to get you that information I have, that interview I had up in Calgary. That covers a lot of this stuff. Q Well, if we haven't covered some things adequately, its because I haven't asked the right questions, I guess. A: Well, I do think that the material from Calgary will come. They've been very cooperative, and I think we'll get that within the next few days. I offered to go up and get it, and they said they'd send it down, so it should be fine. I'll have to see the material to know just what it was., just what the librarian and I covered. I don't remember the details of it. I think there will be quite a bit relevant to my work with the medical profession. Q Uh huh... A: The doctor who followed me as the president of the Alberta Medical Association-¬he was a Calgarian—the librarian who taped me also taped hem, separately. The material, I think was essentially having to do with medical politics. The other fellow wrote a book, based on this information. Q: Really? A: Yes. And I think that probably a lot of the Medical Association work, along with the Health Plan, the M.S.I., the Alberta Health Plan, and what was subsequently Medicare, (they all evolved, one after the other), I think that that will be covered pretty thoroughly in this material. Q That's good, because that's something that we haven't really touched on yet. A: I think that will be in the transcriptions that will come. Q: That's good. We were just getting to what I've been calling in my mind the "community years". When you were involved with the Kinsmen, the Rotary, the Navy League. You were very involved in a lot of community organizations. A: Yes, I was. Q: Did you find the time that you spent in these community organizations was time taken away from your practice? A: No, I can't say that I did. Where the time was taken away from was probably from my own family—my wife and the children. We were very, very busy during the war years. I returned from Montreal, from my post graduate work (an internship really)--! returned just at the beginning of the war. The war had started at that time, and—I think I've mentioned to you—the work that we did in civilian practice was, in part, the responsibility of assessing young men and (mostly men)-assessing their health with regard to going into the services. This was at the direction of the federal government. They were responsible. They were calling up young men according to age groups, and according to whether or not they were married of course. I felt that I had a responsibility to stay in practice here, to continue some of the things I was mixed up with, including, of course, the Sea Cadet Organization. Q. Yes. A: I became the commanding officer. We eventually had, I think it was 10 officers with a corps of around 120 boys. We continued our activities throughout the war, with parades twice a week. Q: That would have taken up quite a lot of your time. A: Yes, yes, quite a lot of time. It was time that I enjoyed, however. Anytime you're working with young people, its fun. And these young boys, they were from about 14 to 18 years of age. You know, many of them went on to do Naval service. Q Really? A: Yes. There were people, the officer corps included people such as Mr. A. C. Anderson who went on to become our mayor. Leslie Grant, who was the Anglican priest in Lethbridge—St. Augustine's priest. The work we did was very worthwhile, I felt, and interesting. Q: That was during the 40fs A: Yes, that was during the 40's Q: And the early 50's? A: Ah, let me see—that would have been about 1947 that I left the corps. Q. I see. A: Yes, I retired as commanding officer, and Mr. Anderson took over. Q. Yes. A: The corps continued as the Sea Cadet Corps, but they also had a younger group also, and this group includes boys in their younger teens—the Navy League Cadets, as distinct from the Sea Cadets. Q: That's a distinction that I wasn't too clear about, and I'm glad to have that cleared up. Its Navy League, and then Sea Cadets. A: Well, the Navy League is in charge. They sponsor the Cadet organization. They are the umbrella. Q I see. A: To continue with the time factor, I think I told you. When we worked in our practice, we would make our hospital rounds in the morning, rather early—when I say early I mean from 8:00 o'clock until about 10 o'clock. Q: What would you say...I know this will be difficult to come up with an average, but how many patients would you say you had at one time in the hospital. Really, just a rough average. A: I would say 10 to 15. Q. So, you would see 10 or 15 patients every day in the hospital? A: That would be an average. It varied of course. And that would be in two hospitals. We had St. Michael's of course, and this hospital. Q Yes. And then the Municipal and the Regional. A: Yes, well, when the Gait closed, of course it became the Municipal. Then, it was rebuilt as the Regional. St. Michael's Hospital had originally started in Lethbridge in the early 30's or maybe the late 20's. The sisters of St. Martha, who have their mother house in Antigonish, Nova Scotia, they took over the Van Harlem hospital, which was located on 7th Avenue and about 12th street. Then, in the early 30's they built St. Michael's Hospital. The Van Harlem, then continued as a nurses residence. St. Michael's was originally three floors, but had one central core. This was added to, first the west wing, and then the east wing. And then they established a nurses residence when they established a nursing school. The Gait School of Nursing was established here back at the turn of the century. And it continued of course until... Q I think it was sometime in the early 80's when it became college based wasn't it. A: Yes, I think that would be about right, the eighties. At that time, the students at the community college would do their theoretical work out there, and their practical work in St. Michael's. ^ Q: Yes, I think they still do a practicum at the Regional. I'm not sure if they do a practicum at St. Michael's anymore. They may. A: I don't know. But when this hospital...Do you want me to start on this hospital? Q: Sure. A: When this hospital closed (I can get dates for you-they're on the wall downstairs). Q: Yes. A: When this hospital closed, I think I had mentioned to you, I had done some work in Boston just about the time that this hospital closed. I'd have to check my dates... Q I think it was in January of 1953 or 1951. I know that you left in February. A: That's when I went to Boston? Q Yes. A: Well anyway, this hospital (the Gait) was just in the process of being closed. The Municipal hospital was in the process of building at that time, and the question was what to do about this building. The question as to what to do with the building was uncertain, because of the fact that there was some information which was available to the effect that the building was built over some of the mine shafts of the old coal mining which went on down along the side of the hill here. Q Really? A: Yes. And there was some question as to the ultimate safety of the building. They actually went so far as to build a new powerhouse just to the north of this building. Q: Yes. A: Do you remember that? Q No. A: The upshot of this all is that when I was in Boston, at this time, when all this was going on, I attended a lecture in rehabilitation by a specialist in rehabilitation medicine which was a new category of medical care. He was interested in the whole subject of rehabilitation. When I came back from Boston, I was enthusiastic too, about this field. So this building was in state of flux as to what they were going to do with it. I brought the matter up at one of the medical staff meetings, that we could use this building as a rehabilitation centre. The staff was at that time in agreement that this was a concept they could appreciate, so Dr. Ernie Poulson... I was the president of the medical staff at about that time, here, and I thought that there was an opportunity for us to at least explore the possibility of establishing a rehabilitation hospital here. Dr. Poulson was the vice president, as I recall, and the two of us decided that we would go and talk to the mayor about this. Which we did. We went and talked to Mr. Shackleford. He was the mayor at that time. Our first approach was rather coldly received. He didn't see that there was any possibility, nor that that was the proper use for this building at that time. Q Did he mention to you that he had some ultimate plans for it? Did he have any idea of what he thought it should be used for? A: No, I think it was all in a state of flux. Nobody really knew what they were going to do with the building. Anywise, he got thinking about it, and he phoned me up one morning, and said: "Arnold, I want you to come over." I wondered what this could be about. I went over and he said: "I think I've changed my mind on this, I think you've got an idea." And we had him on side. Right there. That opened the door for the concept of the convalescent hospital. Q This building was owned by the City of Lethbridge. A: Yes. The city of Lethbridge. To make a long story short, the concept caught fire. He was responsible for getting people like the reeves of the districts around us—one of them was Steve Hoi ton—and other responsible people in the community and rural areas on side. And a board was formed. The members of the board are on the plaque downstairs on the wall. Q Really? A: Yeah. And they got a director, they hired a director to come it. They altered the hospital in some respects, physically and brought it up to date in some regards. The upshot of that whole thing was that we had a rehabilitation hospital. And that was a good thing. Q Yes. A: Yes. When the Gait moved over to what was the new municipal hospital. Q Did this then eventually become the auxiliary hospital? A: No, This was the Gait rehabilitation hospital. At about that same time, the provincial government was—they had as the minister of health, a doctor. He was sympathetic and cooperative in the whole concept of rehabilitation medicine. We were beginning to appreciate the fact, as practitioners, that there was a need for longer term care for rehabilitation, and at the same time recognizing that there was a continuing need for facilities for long term care patients. The upshot of all this was that this was going on at the provincial level at the same time as it was going on here, the spark was...we were not responsible, as far as I know, but we might have been—the concept of rehabilitation started here as early as it did anywhere. Our hospital opened here as the Gait Rehabilitation Hospital. Q Tell me about the typical patient of the Rehabilitation centre. Would it be rehabilitation from trauma caused by, for example accidents, like learning how to walk again after a badly broken leg, or would it be more things like rehabilitation after strokes. A: By and large, let's say right off the bat, that the latter type of case, the stroke patient, the patient with the long term illness, was being cared for in homes, by mothers and fathers and relatives. When we opened this hospital as the rehabilitation hospital, we had so many patients, who needed care in long term facilities, that most of our beds were almost immediately taken up by them. So the rehabilitation concept had to be almost shelved while we were used or operated quite wisely, for patients who needed long term care. Of course, this was the care that had been given at home. We weren't aware of the actual numbers of these patients, because they had been a forgotten population. Cared for in upstairs or downstairs bedrooms in homes. It immediately became apparent that this hospital was filling a need, but the need wasn't for rehabilitation, but for long term care. At this approximate date, the doctor in charge of health for the provincial government was becoming interested and aware of the needs for the rehabilitation throughout the province, including Lethbridge. They decided on a program then, of building rehabilitation hospitals. And Lethbridge got one—the Lethbridge Auxiliary hospital. You see, this was the Auxiliary program. The Auxiliary was for both rehabilitation and other types of care including long term care. It appeared at that time, that when we got our auxiliary hospital, that this one, the Gait Rehabilitation Centre, would be replaced by that hospital. This was over the period of months, maybe even a month or two, as it developed. What happened then, was that the auxiliary hospital was completed, and we were ready to move into it, what was going to happen to this building. We didn't need, we didn't think we needed two auxiliary or rehabilitation hospitals, so this was turned back to the city and districts from which we had taken it over, and they ultimately felt that this was a good place for a museum. Q Yes. A: And they altered it, and changed it, and knocked down parts of it, and rebuilt parts, the extension out to the west, and we now have a museum on the site of the original old Gait Hospital. And that was wonderful. Q Yes. A: The Auxiliary Hospital was ready to open now, and they wanted a name. And I remember them phoning me one day, Mr. Holton was the chairman of the board, he phoned up one day and asked me if I would allow my name to be used as the name of the new auxiliary hospital. I was flattered of course, and very keen about it, but in any case, I spoke to the registrar of the College of Physicians and Surgeons in Edmonton, and he~I spoke to him and I asked him about it because he was responsible for ethics and this sort of thing at that time, and he said that he would speak to the past president—a member of the profession who was a past president of the C.M.A. and past president of the Alberta Medical Association who lives at Lamont, Alberta, and who was also the chairman of the ethics committee of the Canadian Medical Association. He asked him what he thought about the idea. He phoned me—I remember that I was at the convention in Waterton, I think. He phoned and told me that he had talked this over with this gentleman, and the two of them felt that it would be better if I didn't allow may name to be used in this way. That it was something that may be advertising. Q Yes. A: Maybe if I'd been older... Q: Closer to retirement... A: Yes. In any case, I didn't accept the honor. Q: Well, it was nice to be considered anyway. A: Yes. Q: I think they were stickier about what could be construed as advertising back then. A: Yes, there's been tremendous changes in that. But, to stay with this story, we got the Auxiliary Hospital started, and it too became a hospital that filled a real need in the community for long term care. Out of that need, we in Lethbridge eventually built the Southland nursing home, and what is now Extendicare and the Edith Cavell on 5th avenue. They came along very quickly. Q Because it was so evident that a need existed? A: Yes. It was a result of many, many ill people. People ill with chronic diseases, who needed long term care. So that's the story. But the Auxiliary hospital continued to be a locus, not the only locus, but an important one, of rehabilitation in the city and district. We brought in the first physiotherapist, trained in Australia, for the rehabilitation hospital. Anyways, that's the story of this hospital and its evolution from the Gait Hospital to Rehabilitation Hospital to Museum. TAPE 4 SIDE 2 Q: I knew that you had been instrumental in the establishment of the Gait rehabilitation centre just from some of the correspondence in your papers...while it gives one the idea that yes, you were definitely involved, but it doesn't really give you a clear picture of how much you were involved...to what extent you were involved. A: I'm going to tell you that now. Q. Good! How often did you visit your patients in the centre...you wouldn't visit them on a daily basis would you? A: It would depend upon their condition. For the most part, we would try to visit them once a week. Some of them, if they merited more frequent visits, they had them. Q: There have been some really miraculous strides in rehabilitative medicine from the forties to the nineties. A: Oh, yes. I can remember patients with coronaries, coronary thrombosis. In my early years of practice we would keep the patient in bed for three weeks, four weeks? Now they're up the same day! A: Surgery, say an appendix, would be in bed for a week or ten days, or hernias-same thing. Now they're home the next day! Q (Laughs) Or outpatients. My some had a hernia repair just before Christmas—it was day surgery. A: Is that right? (both laugh) Well, there's been tremendous change in the management of medical (which is the heart patient, for example) and surgical patients. Q: Even obstetrical. A: Exactly. They used to be in bed for a week to ten days. Q: Now they go home the next day. A: The next day. Yes its true. And its a good thing. We don't see the complications in surgical patients. We don't see the complications we used to see, you know, when we kept them in bed for a week to ten days. The first time they'd get up they'd have an embolism, from the legs. The whole gamut of medical care, certainly the drug programs, are changing so very fast that one finds it difficult to keep up. Q: Umhum... A: You know, to know how many drugs there are for, and what they're for, and so on. Its just incredible. Q: Yes, I had an uncle who died of pneumonia at the age of 22, in the thirties. That was a disease that you died from back then. A: Yes. You see we had nothing to give them. I told you about that young teenager with the rheumatic fever and the cortisone. That was a miracle, you know? Q Uh huh. It would be unthinkable now for a healthy 22 year old man to die of pneumonia in a city in this country. A: That's correct Except that the problem is becoming—its becoming more of a problem—the control of bacteria and other infectious organisms. The problem of the antibiotics losing their strength because of the resistance of the bacteria. This is becoming more and more a big problem. Q: Yes, I've read that, particularly in the U.S., Tuberculosis is becoming a problem in the large cities, because it is becoming resistant to the medicines... A: That's right. Q: I'd like to get back to the rehabilitation centre. Can you think of a patient that you could say the rehabilitation centre, or the establishment of the rehabilitation program here, made a difference for? Can you think of a patient who perhaps returned to a normal life who might not have done so, had it not been for the fact that there was a rehabilitation hospital and physiotherapists here? I guess that's a pretty difficult question. I suppose—I'm sure that there were such patients. I guess its difficult for you to remember a particular one. A: Definitely, definitely on both counts. We all had rehabilitation in our minds as part of our treatment program all the time. Like a patient with coronary thrombosis. I remember a nurses at St. Michael's Hospital. She was one of the first, in my eyes, who recognized that you don't let a patient just lying in the hospital after a heart attack—you don't let them cross their feet. That slows venous return down there in the leg you see? and may prevent a blood clot. That's maybe not rehabilitation so to speak, but that's sure preventative medicine. Q: Sure. A: Early on, it became apparent to me, and to other physicians, that you don't let your patient lie still in bed. Even back in those days, you had your patient doing exercises in bed. Isometric exercises, where you don't necessarily move a lot, but you tighten up your muscles in your arms...and you do the dame thing with the hips, the thighs, the calves and so on. That's good medicine. Good preventative medicine. Q Yes. A: You're sitting in an airplane? Don't just sit there, get up and walk. Go to the bathroom, go someplace. Don't just sit Q I'm sure though, that having a rehabilitation centre in Lethbridge, having trained physiotherapists, probably made a remarkable difference in some people's lives. A: I'm sure it did. Q People who had strokes, or terrible accidents, where they had to learn to do things all over again. A: Yes. And the same thing with regard to diabetes, or patients with lung trouble, breathing exercises. The use of exercises in breathing, medication would help the cough and so on....there's lots of rehabilitative medicine going on that you don't even think of as rehabilitation necessarily. The physiotherapist has a great place in medicine. Q: Can you talk a little bit about..this is going off on a completely different tangent here, but I don't want to forget about this...You were very involved with the Kinsmen in the early 50's A: Yes. Q Can you tell me a little bit about...I know you were on the executive, but were you the president one year? A: Yes. The Kinsmen is a young men's service organization. At the age of 40, well...you have to get out! From there, very often Kinsmen would move onto Kiwanis, or Rotary of Gyro or one of the senior service clubs. It was an enthusiastic service club. We were young, and we had young families. Everybody was the same...nobody was very rich, we all had about the same amount of money. They were good years. We had lots of fun. But we also worked hard. Q Yes. In the papers, there was reference to the "food for Britain"? A: Well, I'll finish this first. Q Okay. A: Yes, I was president of the Kinsmen club in Lethbridge. I was made a life member of the Kinsmen, and I'm still a member of what they call the "K-40 Club", that is Kinsmen after the age of 40. They're out of the Kinsmen club, but they still continue their association with Kinsmen. We get together once a year or so. Q: I think it was in the Kinsmen papers that a program called "Food for Britain" was mentioned, in 1946 or 19471 think? Tell me about that. A: Yes. Well, it was during the war. Q Oh, was it? Okay. A: Yes, and the National Association of the Kinsmen Club, they started a program of sending milk to Britain. I forget now, but I know it was thousands of pounds that we sent, of dried milk, you know. Yes. It was a national program that was very useful, very appreciated, and successful. Yes. All the Kinsmen, all across the country. Q: That's interesting, because I wasn't even aware of its existence. A: Yes, a very worthwhile endeavor or project. Q. There is kind of a women's auxiliary of the Kinsmen... A: Yes, the Kinettes. Q. Was Islay involved with the Kinettes? A: Yes, she was responsible for starting...she was responsible along with the wife of a banker in Lethbridge, for starting Kinettes in Lethbridge. Q: Really? A: Yes. Islay was the President. I guess the founding president, or the first president of the Kinettes. They had, they took care of social programs, to raise money, they used to have Saturday night dances sometimes at the old Marquis Hotel. Q: Really? A: Yes, where the Royal Bank is now. Q Oh, I remember the Marquis Hotel. It wasn't that long ago. How old were your children then? What years were your children born? A: I'll have to consult with my wife on that one. (both laugh) Q I know that Carolyn was born in the early 40's. Wasn't she? A: Yes, Carolyn was born in, was it 1943? No. Elizabeth Ann was bora in 1939, Carolyn in 1942, Judith in 1946 and Hugh James in 1949. Q: I know that it was after you came back from Montreal wasn't it? A: Yes. Our oldest girl was Ann. She was bom in 39 and died in 1942 when she was about three years old. Q Really. A: And Caroline was bom after that, I think in about 1942. And Then it was about five years or so. I'll get those figures for you. Q: Okay. What did Ann die of? A: She was never well. She was born impaired and she was never, never well. She developed a pneumonia and died. She was never able to function normally. Yes. Q Its very, very difficult to lose a child. A: Oh, its shocking, shocking. Q: You never really get over it, I think. A: No, no. Q Your children, in the 50's would have been, Caroline would have been...I'm thinking, I'm moving into... A: Do you know Caroline? Q No, but I think I've met your youngest daughter. She's a teacher? A: Yes. Grade one. Q: During the years that your children were in school, doing all the things that children do at that age, music lessons, dance lessons, Cubs and girl Guides and all the rest of it... A: You're right. Q Your wife must have been very busy. A: Yes, yes she was. Very busy. Q: You spent long, long hours at the clinic, and at the hospital and with your practice, and she would have been the chauffeur and the... A: Yes. She would be...I would be called out after supper to see a patient or down at this hospital. She, after supper would bundle the three kids into the car, and we would drive down here. They would sit outside there, where we're parked now. I'd come in and see the patient, and to keep themselves warm...we didn't have the heaters that we have now in the car. I mean, we had heaters, but they weren't like the ones we have now. To keep warm, they would sing, she'd lead them in songs. They would carry on, in rounds. Often they've remarked upon it. Q: Well, it was a good way for them to spend some time with their dad. I suppose that on your busiest days, when they were very small, they might not see you at all. A: Yes, but you know, I always made an effort to come home for lunch. Q: Ah, yes. A: And supper, yes. Looking back, I don't feel that I was put upon, or affected adversely by my profession. I don't think so. sure, I was away from the home, but I never felt—I knew what I was getting into when I went into it. There was a group of us. We always had at least 5, and as it grew there were more. But we, I think we gained by having our associates help us, and by helping them. I always thought that the way we practiced was a good "social" maneuver. It worked out very well, I thought. For all of us. Q: Well. I know from our talks and from your papers that your profession was what you felt you were meant to do. I suppose, in many ways, it was all good times. Even what we might call the "bad times", the challenges, the disappointments, were still experiences that you learned from. You could always find something positive in them. A: That's right. Islay had been a teacher before we were married. She had gone to the University of Saskatchewan, took her teaching training... Q Yeah, I think we had talked about that before. That she had been a teacher before you were married, and that she had then decided that she wanted to be a nurse, and that's when you met. A: Yes. And when we got settled in Lethbridge, and when the children were coming along, at an age when they were all in school, Islay went back to teaching, at Alan Watson School. Q Yes. Now we were back in the fifties here. What would you say was the most common reason for an office visit? And did that change over the course of your career in medicine? A: There are several. One is a checkup. You go in to see the doctor because you want a check up. That was one reason. More often than not, there were specific complaints. I didn't do much in the way of maternity work at all. So that wasn't a factor in my practice. I suppose stomach? Gastrointestinal, pulmonary, cardiac, circulatory, metabolic (diabetes and so on)...these were the reasons for people coming to me, or being referred to me. Q: Would you say that most of your patients were referrals? A: No. A lot of them were just my patients. The day of the...the practice of the specialist has changed. To the point where the specialist is confined in his work, by his own decision, to a rather narrow area of medicine. The cardiologist...well there is the cardiologist who is an internist, the cardiologist who is a surgeon, and gastrointestinal specialist who is just concerned with the bowel or the stomach, and another who is just concerned with the pulmonary, the lungs, or metabolic-with diabetes or thyroid disease or adrenal disease... Yes. This is more today than what it used to be. Then there would be a specialist, but he would be a specialist in general surgery, which would be stomach, appendix, gall bladder, thyroid... Q: Pretty well everything but the brain and the heart? A: Yes. The brain and the heart were separate specialties. You had neurosurgeons and cardiac surgeons. These specialist areas have become quite narrow in their scope. The internist is the person who is responsible for a whole range of illnesses including heart, lungs, gastrointestinal, metabolic, rheumatic fever and so on. Now, there are internists who do nothing but cardiology. Q When did you first begin to see that change toward fairly narrow specialization? A: Well, its been a gradual evolution. I don't really know if I can give an answer to that, but I would say that my impression is that it began about, say 15 years ago? And its been gradually moving that way ever since...narrowing. Q: I know that its been a positive thing, in many ways, simply because of the explosion of knowledge...it would be impossible for someone to be as well versed in every area as someone who concentrated on a narrow area of specialization. I know its been positive in that way. But do you think there's been a trade off? A negative effect in any way? A: I don't think so... Q: I just wondered. A: I don't think so. I took sick some years ago with arthritis. I think I was glad to go to Calgary to see an arthritis specialist. I think that's true. Yes, I think fiat's true. As long as there's somebody who's going to lead the orchestra. Somebody who's going to be in charge of me. Send me to whoever you want, but let me come back to you. Q: That's it. I think you'll see family physicians in this role...and I think you see internists in this role as well now. A: I agree. I think that this is how I felt, being an internist. Q Being the coordinator of care, the person who coordinates the whole management of that patient. A: That's true. Somebody has to lead the orchestra. Q I think that, when I mentioned the negative things, I think I had in mind...from some reading in this field. Sometimes there are patients who just get lost They get sent from specialist to specialist and there i s no one leading the band. A: Yes. It happens, and its very unfortunate. They are lost. That's a good way of putting it. Q Yes. And there doesn't really seem to be any mechanism within the system to prevent that. I suppose it is really the responsibility of the patients themselves to have a family practitioner or an internist, to coordinate their care. But if they don't have that, and they get lost, there's...there doesn't seem to be a mechanism in place to see that they get "found" again. A: Yes. That's true. But I think generally speaking, most doctors would recognize the need for this type of advisor, and if they are not able to fulfill that responsibility they would generally see to it that the patient gets somebody. The problem is to get somebody who matches. Some people don't like somebody else because...well for whatever reason. Q: Yes. Different personalities matter. I think that some patients feel comfortable with the doctor in a more or less paternal role..."I know what's best for you...do as I say, and everything will be fine", and other, probably many younger people now, are much more likely to want to be very involved themselves in the decision making process, and would resent a paternalistic type of situation. A: Yes. That's very true. I think that this is a very, very important area of medical care. Q: Yes, I'm very interested in it. It fascinates me to read about it. One can see where there are problems...problems do come up...situations that are not ideal for optimal healing. A: Yes. I think if I had one word to express this area of difficulty for patients, the word is communication. Proper communication, and an understanding by the physician, is one of the greatest needs of the patient. Q: Do you think that communication is one of the most difficult areas for patients? I know that its not like it was 40 years ago. I think that 40 or 50 years ago there was a tendency to see the "Doctor" as omnipotent. Even now, I think that one feels, in some ways, almost like a child when one walks into a doctor's office. Because he or she "knows things that I don't know". And because of that, its become difficult to communicate because it is not a communication between equals. A: That's right. That's true. Its a difficult area.
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