From the editor

SECOND OPINION
BY SIDNEY HARRIS

“I loved medicine but do not miss it”

The following is a response to a letter from Howard Spiro, M.D., that appeared in the Autumn 2003 issue of Yale Medicine.

Dear Howard,
That you should respond to my essay with a letter half again as long as that to which you responded [“Knowing When It’s Time to Quit,” Summer 2003] brings to mind G.B. Shaw’s coda to a letter, “Forgive me for writing a long letter but I did not have time to write a short one.” My response to you will be shorter.

My two main reasons for retiring are relevance to my medical community and lack of an adequate intellectual schema in which to incorporate new knowledge. I was bothered by the impending irrelevance that I had seen afflict older physicians. Friends of mine, particularly doctors and attorneys, concur in the recognition. Does being troubled by that prospect reveal inadequate ego strength or simply an accurate perception of reality? Choose one!

The problems of understanding and incorporating new knowledge and its effect on how I wanted to practice are linked to your statements about continuing to practice in a changed capacity and the wisdom that comes to some with age. All the kindness and wisdom in the world are not, in my opinion, worth much if not backed by up-to-date knowledge. I suspect that doctors who practice part time in clinics after retiring are not offering first-rate medicine.

You take me to task for not being a “mid-1930s liberal.” I plead guilty. The implication that somehow it was immoral to retire and deprive the world of my (supposed) talents is a bit harder to take. Perhaps I should have spelled out my thoughts more clearly. For me to continue to practice and encounter the loss of respect of my colleagues—and your colleagues know you better than you know—and be unable to use new information properly would have been to practice under false pretenses.

Do I think everyone should retire at a specific age? Of course not. With rare exceptions, however, there comes a time when older physicians should make way for younger ones. I chose what I chose. I make no apologies. I loved medicine but do not miss it. I am very happy in my current state.

Your longtime friend and student,

Herbert J. Kaufmann, M.D. ’59
Bedford, N.Y.

For more on this topic, see the online Yale Journal for Humanities in Medicine at info.med.yale.edu/intmed/hummed/yjhm/.

Strong support from chief helped female surgeons

I read with interest the article on the growing number of women in surgery [“Closing the Gender Gap,” Winter 2004] and was pleased that Barbara Kinder mentioned William Collins as one of those who strongly supported women in the surgery program. As the first woman resident in neurosurgery at Yale (and the third to be board-certified in the country), I was fortunate that Dr. Collins literally “took a chance” and accepted me on the resident staff. I recall early in my residency when the chairman of one of the major neurosurgery departments in the country said to Dr. Collins (in a voice calculated to reach me), “Bill, I thought you came here to build a first-rate program. How do you expect to do that after you bring a woman on staff?” Dr. Collins’ support was invaluable not only during residency and when I was a faculty member, but later in my career as well. Thanks, Barbara, for remembering.

I would also like to echo Dr. Kinder’s reservations about the reduction in resident duty hours. As one who attended a medical school in New York with a county hospital affiliation, I know it was not necessarily the fatigue of house staff that caused the errors that aroused the concern of legislators, but the inability to get senior staff to respond to night call. For example, in my third-year obstetrics rotation I delivered more than 30 babies, and I was “taught” to do pudendal blocks (among other things, like breaking a clavicle for a shoulder dystocia) by the night nurse. I agree with Dr. Kinder that the diffusion of responsibility that occurs with the shortened hours is a significant negative. And perhaps more importantly, it will do little to solve the problem.

Joan Venes, M.D., HS ’67
Sacramento, Calif.

Cos, not Ephesus, was Hippocrates’ birthplace

In reference to the caption under the photo of a sycamore tree on Harkness Lawn [“A Nurturing Vision,” Winter 2004], Hippocrates was not born in Ephesus, but rather on the island of Cos off the Ionian coast.

William B. Radcliffe, M.D. ’58
Mitchellville, Md.

Dr. Radcliffe is correct. Due to an editing error we stated the incorrect birthplace for Hippocrates.

From the Editor:

Connective tissue

I still have vivid memories of my first day of dorm life. The year was 1977, the city was Baltimore and the weather was what you’d expect in late August: hot and very, very humid. Music filled the quad, everyone was friendly and at dinner that night there was a communal air that endured long after we had moved off the Hopkins campus for the thrill of living on our own.

That was Maryland, not Connecticut; college, not med school; and it was more than 25 years ago. Nonetheless, the experience held the same charm for me that medical student Jenny Blair conveys in her memoir of four years in Harkness Hall (“That College Feeling”). Dorm life has its downside, but it’s the one time many of us will live in close quarters with a large group of our peers.

The “connective tissue” linking a community of physicians is also a thread in our cover story about the dilemmas that face medical practitioners in their professional lives. The values instilled by institutions such as Yale and reinforced by the relationships that begin here form the basis for ethical decision making for years to come. Our third feature (“Journey of the Heart”) describes another type of connection, this one a collaboration between physicians in New Haven and Tehran that revealed the genetic cause of a heart disorder affecting children around the world. Without good communication among scientists from different worlds, this discovery would not have occurred.

To meet our goal of keeping the Yale family in touch, we rely on you, our readers, to share stories of interest to your colleagues, friends, patients and former classmates. Whether it’s a brief note for the Alumni section, a profile suggestion for Faces or an exciting new direction in research or patient care, we’d like to hear about it. Drop us a line the next time you feel like connecting.

Michael Fitzsousa
michael.fitzsousa@yale.edu