HOW I FOUND MY RHYTHM WHEN THE MUSIC STOPPED

At a time in everyone’s life, we come to find ourselves in a situation where the music stops, and we must go on.  The unfortunate truth about life is that the unexpected will happen. Some of us learn from it, some of us change because of it and some of us find our life’s calling because of it. The latter was the case for me.  After our dad picked us up from middle school, we spent that afternoon like we had every afternoon that month. We went to the oncology unit at the hospital, where my brother was admitted.

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THE MAN IN A BLUE SARONG

I remember him. I remember the man in the dark blue sarong the same way I remember the lines on back of my own hand. He was hunched over next to a column on a dirty platform at a railway station in Calcutta, India in the middle of the harsh summer sun. His hands were withered, his fingers and toes looked like tiny nubs, and he was completely malnourished and alone. He had opaque blue eyes, as if fog had taken place of his irises and pupils.

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PATIENT “OWNERSHIP”

I studied insects in college; my favorite insects were the bees (I found them diligent and so helpful to humankind).  One of my favorite classes was about medical diseases caused by insects. My professors noticed my interest in the medical side of things and connected me with a professor who did clinical research. Our work focused on a clinical trial for children with intractable epilepsy and exposed me early on to patient care and patients.

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A physician (and a native Kentucky son) has also served on the US Supreme Court. Samuel Freeman Miller received his medical degree from Transylvania College in 1835 and practiced in Barbourville, Kentucky for a decade. He was a self-taught lawyer, passing the bar in 1847. His opposition to slavery led to a move to Iowa and in 1862 Abraham Lincoln nominated him to the Supreme Court where he served until 1890. His legacy includes writing more opinions than any other Supreme Court judge in history. He was also known as a “maverick” often representing the dissenting opinion.


Many factors appear to limit physician’s pursuit of public office. Medical education demands a long training period with medical school, residency and often a fellowship. This is followed by the time demands of starting a career and building a practice as well as trying to balance a family life. A continuous educational process is required to stay abreast with advances in diagnostics, pharmacology and other therapies.


In contrast to physicians, attorneys make up the bulk of public office holders accounting for 70% of US Presidents, VP’s and cabinet members (25/44 Presidents, 32/45 VP’s). Since 1957 all Supreme Court Justices have been lawyers.


Michael Riorden suggests that lawyers have become the “high priests of American politics” because they are willing to devote energy, time and money to politics since it enhances private careers and gives better access to the judicial system. He goes on to point out the differences between medical and legal education approaches. Law school encourages a linear, deductive method of thinking using case method – presenting the facts of the case, identifying the appropriate precedents and arguing the merits. Riorden argues that this does not foster the forward thinking and the open mind that a public official requires to weigh multiple points of view and to meet the needs of a diverse citizenry.


He contrasts this deductive approach to the integrative method used in medical school i.e. looking at multiple sources of data; history, physical exam, lab studies, epidemiology, social and financial factors. This requires revising diagnosis and therapy as facts emerge during the course of therapy instead of assuming a stance and arguing its value ex post facto. The legal approach requires advancing a specific point of view that may suborn larger societal values.


He concludes that elements of a medical education “valuable to a governing official” include



In addition medical school “provides an unparalleled view of human behavior” and fosters “imperturbability, a coolness to operate during periods of crisis”.


Thus, it would seem that physicians have the temperament and training to contribute to a leadership role in the political process. As to electability, a Gallop Poll in 2012 showed that 70% of Americans rated doctors as high or very high in their ethical stands and honesty compared to 50% for the clergy and 19% for lawyers.


Greater involvement in the political process would require a great deal of soul searching. Can one focus his attention from caring for the individual to caring for society as a whole? Can he risk the insecurity of an elected office to the security of a protected income to meet his family's needs? Can he (and his family) bear the constant scrutiny of the public spotlight?


The recent election has revealed multiple political currents likely to reshape and reform this country for many decades. Physicians do have a valuable voice to add!


References

  1. Petterson, Mathew. (Nov. 2016) The characteristics of physicians elected and serving in state legislatures and the United States Congress. MD Thesis, University of Arizona Medical School.
  2. Physicians in the United States Congress. Retrieved from https://en.m.wikipedia.org/wiki/10/26/16
  3. Ross, Michael A. (2003) A Justice of Shattered Dreams: Samuel Freeman Miller and the Supreme Court During the Civil War. Louisiana State University Press.
  4. Riorden, Michael L. (1986) “The path to public office: medicine versus law.” Perspectives in Biology and Medicine Vol 29, No2, 315-325.
  5. Huddle, TS and Maletz, K. Physicians involvement with politics – obligation or avocation. Retrieved from journalofethics.ama.assn.org/2011/11/ ccas2-1111.html

Rising healthcare costs and demands from the public for increased coverage have led to an ever increasing presence of government in the traditional patient-physician relationship. It has now become the patient-insurance/government-physician relationship. The scope of practice legislation and health policy continue to become more complex increasing the need for more physician advocacy and commitment to the process. However, over the history of our country physician legislator involvement in government has declined.


Physician participation in the founding of our country is seen in the Continental Congress where thirty-one of three hundred and sixty-three members were physicians. These were people active in their communities, educated, articulate and aware of patient’s needs and fellow citizens concerns. They were willing to face the risks and the uncertainties of a new form of government. This effort carried thru to the Declaration of Independence with six physicians noted among the fifty six signers and to the Constitution with two physicians among the thirty-nine authors.


In the first one hundred years of the US Congress two hundred and fifty-two served two year terms but subsequent numbers had dropped until a decade ago when the numbers again increased, doubling to nine- teen physicians. In the One Hundred and Fourteenth Congress (2014-2015) physicians occupied three Senate seats including Rand Paul of Kentucky and fifteen House seats.

BY LOWELL QUENEMOEN MD

William Henry Harrison

A study by Mathew Petterson in 2016 looked at one hundred and two current legislative bodies including The US Congress, forty-nine states with bicameral legislatures, Nebraska with a unicameral legislature and DC with a unicameral council. Of the seven thousand nine hundred and seven seats reviewed 1.2% were held by physicians. In this group 10% were females and 90% males, 69% were 55 years old or older, 70% were Republican and 30% Democrat and 86% were MD’s, 10% DO’s and 3% were foreign medical graduates.


At the Presidential level recent candidates have included Rand Paul (Senate R-KY), an ophthalmologist, Ben Carson, a neurosurgeon, Ron Paul (House L-TX), an obstetrician and Howard Dean (Governor D-VT), a family practitioner. Only one elected president, William Henry Harrison (9th president) had a medical background. He attended the University of Pennsylvania Medical School for a brief period but dropped out to pursue a military career. He came to national prominence with his defeat of Tecumseh and the Shawnees at the Battle of Tippecanoe. Shortly after his inauguration in 1841 he developed pneumonia and died three months later giving him the shortest tenure of any president in history.

LOWELL QUENEMOEN, MD

Lowell Quenemoen MD is a retired clinical neurologist having practiced in Columbus, Ohio for 20 years before moving to Billings, Montana for a further 15 years of practice. At the time of his retirement he was a Clinical Associate Professor at the University of Washington Medical School Department of Neurology. He is a graduate of the University of Minnesota Medical.