Dr. Frank Stinchfield taught me and a few hundred other residents in orthopedic surgery at New York City's Columbia Presbyterian Hospital. He was our undisputed Grand Old Man of Orthopedics, in his time one of the most prominent orthopedic surgeons in the world. In my time he was wonderful, friendly and wise-a big, smiling, grandfather whose plain Midwestern manners stuck out like the sun among the darker heavenly bodies of the Upper West Side's professorial (read distant, arrogant) medical establishment.
Dr. Stinchfield's specialty was total hip replacement-VIPs traveled thousands of miles to be his patients. Yet after doing one with him, he would routinely say "that was great boy, you know you can do that operation better than I can." Certainly none of us really believed this, but it still made you feel good enough to call home and tell the folks.
In the complicated world of doctor-patient relationships, "informed" consent and the like, Dr. Stinchfield was refreshingly old school. To the patient facing surgery his pre-op discussion of risks and benefits was generally something like: "Anything can happen here but I give you my word that I'll do the very best I possibly can". He meant it and they knew it and however the operations came out they loved him. (Remember these were the early days of joint replacement and they didn't always work yet.)
Years before, Dr. Stinchfield had fallen off a horse, and over time his back injury and complications from surgeries left him in constant pain, barely able to get out of bed. At the time, I had to sleep in the hospital every fourth night, so it was fun to visit "the Boss" in his hospital room; the one bit of New York he seemed to have picked up was staying up late. We talked about the old operations he did, field hospitals he set up during the war, the famous orthopedists he knew (He knew them all). We also talked, a lot, about his patients. Dr. Stinchfield liked to take care of sick people.
Construction of our brand new hospital building, next-door to the current one, was completed about the time that "the Boss" was first able to take some steps. The building was tremendous. Gleaming opulence made of the finest stone and metal, its magnificence was perhaps best felt in the majestic entrance and lobby, which soared four stories high. We decided to walk him over to see it.
He leaned on one or two of our arms, eyebrows up, neck painfully extended as far as it would go-he still couldn't see to the top of the lobby. He looked like a farmer at the World's Fair. It was a little bittersweet, but we were happy to be there with him seeing the impressive new digs for the first time. There was only one thing wrong though he wouldn't say a word.
Overwhelmed by the building? Or perhaps it was the pain? We kept asking 'what do you think?' but he wouldn't say anything. His annoyed facial expression, however, said enough. We all agreed that he must have been in pain, so we took him out the grand electric doors, back across the street. Breathing pretty hard, Dr. Stinchfield finally leaned on a parking meter near the old hospital, and catching his breath, he declared, "Well I'll tell you one thing, boy, it's not about taking care of sick people". We didn't know which particular boy he was talking to, but every one of us knew that he was right.
Glitzy buildings were just the beginning. Image consultants, PR firms, advertisements are all standard in the medical world today. Hospital administration is largely concerned with the question of "how can we get more (paying) patients through here?" Few of us are surprised, of course; the market for patients is competitive and payments are thin-hospitals and doctor's practices do fail quite often. The reason we just can't get comfortable with the idea of medicine as a business is this though: when a ship is going down, they don't "market" the life jackets.
There weren't that many of us in the old days. We felt needed because we were, and being needed is a powerful drug. It kept us up working all night, every few nights, for five years as residents. It's really the same drug that keeps parents up with a sick baby, ministers up with a desperate parishioner, or soldiers up taking fire to save their buddies. But now my administrator says that the guy down the block will do the job if I don't persuade that patient to come to me. So what do I offer a patient who, we are told, really doesn't need me? A multi-million dollar lobby. The Boss saw what was really behind that glitzy facade, and he saw what lay ahead as well. And of all the things that take the joy out of practicing medicine, that is perhaps the most insidious.