“All you need is a reasonable set of brains, a willingness to listen to your professors, the memory of an elephant and you can become a doctor.”
It was my uncle, an ear-nose-throat specialist, who told me that when I was 16 and considering a career in medicine. He was dead serious and, in retrospect, pretty close to the mark what was required at that time to graduate with an MD degree.
That was more than half a century ago and things are different now.
In my day, I was one of in a class of a 110 students, and apart from memorizing an impressive list of medical books, we had to listen to professors who expected us to pay careful attention and make notes of their opinion how to diagnose and treat various medical problems without once questioning the validity of their teachings. Asking them questions was simply not done. Pity the students who missed absorbing the strongly held opinions of our professors when exam time came.
I followed my uncle’s advice and studied hard. I became a fully qualified physician, but quickly realized I was still an inexperienced doctor imbued by many medical and religious dogmas that did not appear to have a sound basis.
During the graduation ceremony, the enlightened dean of our medical school admonished us to continue to keep up to date with what was starting to be a revolution in medical science and technology and to question the ethical consequences of all the changes. That advice was a sea change in a culture of rather rigid traditions and unquestioned authority.
As children, we were raised in a culture of being respectful to authority, and apart from the normal teenage rebellious interaction with our parents, rarely dared to question our teachers, and certainly not any clergy. We dressed and behaved mostly as we were told, observed religious practices and believed firmly most of what these people in authority told us.
I had the good fortune of growing up in a family of college and university educated people and no subject was taboo for discussion. That environment planted the seeds of a lifelong habit of critical appraisal of just about everything that was considered sacred in my profession and life in general. Many values withstood this re-evaluation process, but others were found to be merely mythical or outright wrong.
Even though Dutch society was on the verge of a profound cultural change, the medical profession was still steeped in a stifling environment of traditions and I found the lure of a greater sense of freedom and flexibility, plus the incredible spaciousness of the North American continent irresistible and decided to pursue a career in family medicine in this country.
In the process of my further professional development, I have continued to be an active supporter of challenging many firmly held opinions, rules and laws that did not make much sense.
It took years of court challenges to establish that women have every right to control their childbearing choices without authorities meddling in them. Even today there are some physicians who refuse to prescribe the birth-control pill because some clergy threatened them with eternal damnation.
Now, we are embarking on another important issue, where many of the old beliefs and values are challenged.
I alluded to before how little attention was paid to educating physicians about end-of-life issues during my early years as a doctor. We were taught to deny adequate pain control for unsubstantiated fear of killing patients and ignored the basic rule for any physician to comfort always, even when a cure was out of the question.
As I grew older and became more uncomfortable with how poorly we care for people near the end of their lives, I made sure I was up to date in all the scientifically sound aspects of providing palliative care.
I have been qualified to teach the discipline at UBC to our future doctors for a number of years.
I and other physicians strongly hold that it is not our role to be executioners.
On the other hand, I applaud the honourable judge to challenge our politicians to provide a legal choice for terminally ill people on how they wish to die.
This is a matter that needs a lot more civilized, sound and factual discussion.
