Posts Tagged 'Marcus Welby'

A Country Doctor Watches Marcus Welby, M.D.

The year is 2012. A 58-year-old veteran Family Physician who has just finished a day with more human heartaches than clinical triumphs settles down among the pillows with his wife in front of his MacBook to watch a movie, delivered wirelessly over the Internet:

The year is 1969. A 62-year-old veteran General Practitioner who has just seen his health threaten to fail him, speaks passionately to a group of doctors about how general practice is not dead and general practitioners are not dinosaurs. For the next 98 minutes he proves how much he cares, how well he knows his patients, and how often he is willing to go out on a limb when he feels there is an ethical stand to be taken.

The pilot episode of “Marcus Welby, M.D.” was called “A Matter of Humanities” (how often do you hear that word in medical circles today?). In his passionate speech to the young doctors at the hospital where he had just been treated for his heart attack, he said (and I paraphrase):

We aren’t treating a this or a that, we are treating our patient.

That is pretty much what Family Practitioners say today, and we still aren’t dinosaurs. In fact, the “new” or re-born idea of the Patient Centered Medical Home and other such political reforms may make us more central to the health care machine than we have been since the days when the big HMOs wanted us as “gatekeepers”. Regardless of how our standing with the politicians and insurance companies has come and gone, our patients have kept on coming to see us.

In 2012 more than a few people speak disdainfully about how “the days of Marcus Welby are long gone”. Google has 17,600 search results for that exact phrase, if that is any indication. But many people seem to speak of him without actually having watched or at least remembering much of the show.

I have heard people scoff at his clinical understanding, and I remember once seeing an episode where he used a car battery to deliver a shock to a patient’s heart. But, this was Hollywood fiction – let’s not forget that Marcus Welby himself was a fictional character – and defibrillation and cardioversion were relatively new inventions.

Marcus Welby and his fictional colleagues obviously practiced with the medical knowledge of that time. We may smile at how his attending physicians kept him in the hospital for twelve days or more for a simple heart attack. That may seem archaic by today’s standards, but it may actually have been more humane than what we are doing today with our same-day surgeries and drive-by deliveries.

The purpose of most episodes of Marcus Welby, M.D. was not to illustrate the clinical aspects of a particular disease or its treatment. Most of the stories were about how disease affects people and how a wise and caring physician can help his patients, even in situations when there is no cure to be offered.

An interesting theme in the show is the mentor relationship between Welby and his young associate, Dr Kiley. In spite of his youth, fashionable (for his time) hair and motorcycle, the younger physician represents a more conservative view than Welby. The older physician is more liberal, less distrustful of human nature, and more altruistic than his protégé.

It is obvious that doctors in 1969 had less advanced tests and treatments to offer their patients than we have today, but the ironic thing to me is that Marcus Welby’s patients got a lot more in a way because of his exceptional personal involvement, passion and courage. In that sense, the shows are totally refreshing. Medicine today, with its focus on guidelines and measurable data, has become a rather faceless bureaucracy. I think I know why many people still remember and mention the Marcus Welby character by name. He gave medicine a face, a personal flavor that people still want today. There is a lot of talk and theorizing these days about how medical care is organized and delivered. For example, we read about Accountable Care Organizations; whatever happened to accountable individuals?

Medical knowledge is always subject to change, but the ethics of medicine are a lot more timeless. Marcus Welby, M.D. tells the human stories as they relate to the medical facts of that era, and they are still captivating and thought provoking 43 years later.

My wife and I will be back for more of Marcus Welby, M.D.

Osler said “Listen to your patient, he is telling you the diagnosis”. Duvefelt says “Listen to your patient, he is telling you what kind of doctor he needs you to be”.



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