Starting point

SECOND OPINION
BY SIDNEY HARRIS

Yale should produce more primary care physicians

I would be truly impressed if Yale pursued the path of producing more primary care physicians. As a “liberal” institution of higher learning, where is the responsibility? Lifestyle is important but that was not what medicine was or is about. As for an ophthalmology attending seeing 40 to 60 patients in 10 hours, I am speechless. Who is teaching?

Harvey Davis, M.D., HS ’69
Virginia Beach, Va.

Primary care is vanishing as a practice model

Regarding “Taking the E-ROAD” [Yale Medicine, Autumn 2007], I’d like to tell the academics who decry the decline in the number of primary care physicians why I left primary care in 1968. It had nothing to do with lifestyle or economics. I didn’t leave primary care, primary care left me.

The whole practice model was disappearing. I lay awake nights wondering what to do and told my patients that if they could scare up 1,500 families who would let me deliver their babies, treat their fractures, take care of their kids, etc., then I would stay. This was a feeling shared by many of my contemporaries. But the climate was rapidly changing and the academics were clueless as to the reasons. Family practice disappeared, never to return. The change wasn’t just within the medical community but in American society as a whole. As an example, house calls didn’t disappear because physicians wouldn’t make them but because people stopped asking for them.

The young doctor who wrote the article has never been exposed to one generalist supervising care. The medical school hospitals I am familiar with (Yale, where I went to medical school, and Dartmouth, in the area where I now live) have simply never had that model. And I don’t know that they can.

Following my wife’s surgery, a serious post-op problem was handled without talking to her family. Consults were gotten, care discussed and treatment ordered without talking to the patient’s spouse or family doctor until, after four days, in desperation, the husband (me, an M.D.) insisted the primary care M.D. be called. With his background knowledge the primary care M.D. corrected the problem immediately. When I protested the lack of communication I discovered that the primary care M.D. had no privileges even though he is part of the Dartmouth-Hitchcock Medical Center system. I have yet to be talked to by anyone but the intern—even three years later! Today’s medical student never sees the kind of practice that was once so common in community hospitals. He or she has no role model, a fact that is sad but true. The current primary care model bears no resemblance to what I knew and the modern version is no replacement.

Robert P. Gerety, M.D. ’52
White River Junction, Vt.

Starting point:

Lessons from Uganda

When I returned from Uganda in July, people who asked about my reporting trip to Mulago Hospital assumed that the Yale attendings and residents had gone there to teach. It would seem to make sense that professionals coming from one of the leading universities in the richest country in the world and with access to the latest medical technologies would have much to teach the doctors and medical students at a hospital in one of the world’s poorest countries. In fact, the reverse was often true. In the middle of one Yale doctor’s first day on the wards at Mulago, he lamented how ineffectual he felt. Said Sam Luboga, M.D., deputy dean of the Faculty of Medicine at Makerere University in Kampala, “When people come here they can really feel bewildered. They find a hospital full of patients, without drugs, without supplies.”

At Mulago the Yale doctors became the students, with a lot to learn from their Ugandan colleagues. Denied all the accoutrements of modern medicine that are part of their daily lives, the Yale physicians fell back on the most basic tool of medicine—the physical exam—at which the Ugandan doctors excel. This is not to say that the Yale doctors had nothing to offer. While at Kampala, the Yale attendings and residents taught evidence-based medicine and provided new models for interactions with patients. The collaboration has also brought to Uganda textbooks and access to electronic medical texts. Both Makerere University and Yale University stand to benefit from the collaboration, which is expected to improve clinical care in New Haven as well as in Uganda.

In this issue we also feature profiles of two doctors who specialize in the heart. John A. Elefteriades, M.D. ’76, HS ’83, chief of cardiothoracic surgery, learned the basics of cardiology from Lawrence S. Cohen, M.D., HS ’65. The two started as student and mentor, became colleagues and are now co-authors of a book about the heart, Your Heart: An Owner’s Guide.


On November 30 we learned of the passing of Nicholas P.R. Spinelli, M.D. ’44, a warm, kind and generous man and a good friend to all of us at Yale Medicine. When we were next door to the Office of Alumni Affairs, he often took the time to chat with us and ask us what stories we were working on or to suggest ideas for articles. And he always had something nice to say about our latest issue. We will miss him.

John Curtis
Managing Editor