Golden Age of Medicine

"If any picture has been overdrawn, surely it is that of the idyllic country doctor, who guards his flock of loyal families with a rough and ready skill through the years. While this picture may have had a certain poetic truth in the nineteenth century, it is a far cry from the realities of the present. The rural physician may make up with art what he lacks in science, and the heroism and resourcefulness of the "horse and buggy doctor" may win our admiration, but one cannot insist that, by modern standards, he renders a high quality of medical service."

Frederick D. Mott, M.D. and Milton I. Roemer, M.D., M.P.H., Rural Health and Medical Care (New York: McGraw-Hill, 1948), excerpted from pp. 182-184.

What then is the portrait of America's contemporary country doctor? Any generalized picture is difficult to draw, but out in the villages and farming communities one finds a rather characteristic type of rural doctor, presenting a quite different picture from that of the typical city physician. This is less the case in the enterprising small urban trade center, but out in the country districts, the physician--close to the soil and often a farmer himself--takes on his full share of local coloring. Generally overworked and under- paid, graying, he holds forth in an office in his home--or often in close association with the drugstore in which he may have a financial interest. His office is meagerly equipped, commonly lacking all but the very simplest aids to diagnosis or treatment, and rarely tended by an office nurse or other aide. The roll-top desk may be piled high with largely unread medical journals, drug-house literature, and an assorted collection of pharmaceutical samples. All too often used and unsterilized instruments may be seen lying about and the examining table will reveal the telltale dust of disuse.

Those familiar with rural medical practice know that this picture is not overdrawn, and yet the aging country doctor is not to be blamed for his inadequacies. The environment of country practice is one of continuous frustration and continuous inability to do the things that the thoughtful physician realizes are indicated. Tied to his office to make even a moderate living, and with sick patients counting on his help, he rarely can find the opportunity to go away for a state medical association meeting, a refresher course, or post-graduate studies, and, after a while, he loses interest in the idea. As the years go by, he tends to become more firmly lodged in an intellectual rut, and soon the detail men from the various drug houses become his chief source of information on current therapeutics. Diagnostic methods stay pretty much as they were, with small use of such auxiliary refinements as the x-ray or the bacteriological laboratory. It is no surprise that after years of virtual isolation professionally some country doctors go completely to seed and lose all their effectiveness as providers of medical service. Even local medical societies, which might tend to provide a certain amount of ethical and professional guidance to practitioners, are as a rule much weaker in every way in rural counties than in the cities.

The qualifications and services of rural physicians are by no means all of one type. There are many notable exceptions, many practitioners well past middle age who have kept up to the minute with modern medicine. There are many who have been responsible for the establishment of hospitals, who foster the adoption by their colleagues of the latest techniques of diagnosis or therapy, and who keep their lines of association with specialists and institutions in the nearest cities. Even in the case of less enterprising practitioners, there can be no doubt that, forced to get along without refined diagnostic aids, there is a tendency to develop a certain diagnostic sense and an ability to "see the patient as a whole," often quite lacking in the overspecialized city doctor. Then, of course, some young alert physicians are, indeed, going into rural districts, sometimes "buying out" the practice of a retiring practitioner. New patterns, such as the establishment of the doctor's office in the local hospital, are developing. It can hardly be denied, however, that by and large the rural doctor practices a brand of medicine many years behind the times. Thorough examinations are exceptional, and the dispensing of pills to strike at symptoms, rather than diseases, comes to be his major role.

If any picture has been overdrawn, surely it is that of the idyllic country doctor, who guards his flock of loyal families with a rough and ready skill through the years. While this picture may have had a certain poetic truth in the nineteenth century, it is a far cry from the realities of the present. The rural physician may make up with art what he lacks in science, and the heroism and resourcefulness of the "horse and buggy doctor" may win our admiration, but one cannot insist that, by modern standards, he renders a high quality of medical service.