Doc:Then and Now with a Montana Physician

   This post consists of a review of a book entitled Doc: Then and Now with a Montana Physician. It is authored by R.E. Losee, a country doctor who remarkably became a world-renowned orthopedist. John Badgley gave the book to me without comment or explanation. I suspect that he thought that I would identify with the author since both Losee and I are retired physicians. Importantly, the book appears to relate to John as much as it does to me. Both the author and John have a Montana connection, love the state, its geography and its people. Both John and Losee are similar in temperament, political inclinations and devotion to a secular based morality.

   The book is a memoir of a Montana physician, and Yale Medical School graduate.  The book describes the author’s conflicts with the medical establishment as he struggled to find the meaning of the title Doc., and more importantly, the meaning of his contemplated life. The book consists of an introductory chapter followed by a series of anecdotes describing the journey of a country doc to a world-renowned orthopedist. That his patients profited from his journey is in fact the important subtext of the book.

   The introductory chapter summarizes Losee’s medical education.  Unfortunately it is confusing with a time line that is indecipherable. This difficulty is probably attributable   to the vagaries of memory of an old man. Losee describes the inadequacy of his medical education, lamenting the failure of his training to prepare him for meaningful patient relationships, surrendering instead to scientific pursuits. His premedical education was at Dartmouth where he majored in chemistry. While at Dartmouth he memorized formulas, which were meaningless then and thereafter. His obituary states that his Dartmouth years were the worst of his life.  His medical education at Yale was equally disappointing.  Although he fails to describe his experiences at Yale, he states that he spent his life trying to forget the lessons learned at that august institution. Apparently the lessons were incompatible with his expectations of what it meant to be a doctor.  The   model of a doctor was based on the lives of his grandfather and great grandfather who practiced medicine when medicine was mainly a social pursuit, only to be displaced by the concept of medicine as a scientific endeavor. In 1910, Abraham Flexner wrote a report condemning American medical education, which was socially oriented and often taught by the apprenticeship method. He preached that medical education should be modeled after the German system, wherein teachers were the role models rather than doctors. The teaching of Medicine changed and would never be the same.

 Following his graduation from Yale, and after being denied an internship at Yale, he obtained an internship at the Royal Victoria Hospital in Montreal. He then headed west, to complete a rotating internship in Denver, Colorado, which once again denied him the opportunity to develop the skills that were pertinent to relationships with patients. He then completed his peripatetic across the country, eventuating in a practice in Ennis, a small l town in Montana, where he finally found himself and the meaning of his life. The subsequent narrative interweaves his experiences with patients   with his appreciation of the beauty and majesty of the Montana geography.

   The Montana anecdotes start with his experience as a general practitioner, stressing his experiences delivering babies and treating everyday maladies typical of a general practice. Almost imperceptibly, his medical practice changed from family practice to surgery and then an orthopedics.  He realized that his knowledge base in orthopedics was inadequate and thus threatened the lives of his patients. In response he returned to Montreal to further his internship in orthopedics. On return to Montana, we witnessed a gradual change in the nature of his practice. It became more scientific and technologically oriented. At one point, he experienced an epiphany that he had actually become a scientist. Consequently, he became interested in the mechanisms of disease and in particular of the unstable knee. This experience led to a life of scientific pursuit, eventuating in series of publications, attendance at scientific meetings and honorary lectures.  Although never board certified, he became an acknowledged authority on abnormalities of the knees, finally obtaining an honorary degree and the title of professor. Ironically, he discovered God when he realized that his skills alone were inadequate to achieve success for his patients. He describes how he prayed that an operation would go well.

The book ends with a reverie, reprising the meaning of the author’s life.  The subtitle of the book Then and Now with a Montana Physician implies that the author retuned to traditional practice, an implication that is misleading. The past was gone and what he experienced was not a return to former life, but simple nostalgia, nostalgia for his grandfather and great-grandfather and all they stood for.  There was no turning back. He was left with the title of Doc, an honorific obtained from grateful patients and their treasured memories.  The term encompassed respect and affection, and includes concepts of image building and image reception, The image is as much a creation of the adoring and needing patient, as it was imposed upon them by a sympathetic and occasionally manipulative physician. Times have changed and the needs of a public for a physician scientist, has superseded the needs for a loving, albeit limited knowledge based physician.  We cherish the loving healer, but need and revere the scientist, an important subtext that makes the book worth reading.

Posted by Arthur Banner