Though he had never gone to medical school, a man suitably named Carver bluffed his way last year into a job as a staff surgeon at a New York City hospital. However, prior to wielding a scalpel, or so they say, he had to move on because his department was closed down. Whereupon, a hospital staff colleague, who also happened to be medical director of a New York women's prison, recommended "Doctor" Carver for the post of assistant director, and he got the job.
After he was caught-through abuse of his prescription pad-a Corrections Department spokesman was quoted as saying, "Buy he was an extremely good doctor. All the inmates liked him."
What's interesting about this sad case is that every year brings a few unmaskings of medical Walter Mittys, and almost invariably their patients agree that their bogus doctors were just fine-and sometimes, in fact, the reviews are enthusiastically favorable. As for the opinions of their medical colleagues, it must be recognized that the subject is extremely delicate, since it is usually a file clerk, rather than a fellow physician, who detects the fraud. What this reveals about medicine's claims of being a self-policed profession is a separate topic, but for the moment the main point to be observed is that Carver got the prison job upon the recommendation of a doctor who had had the opportunity to become acquainted with his professional performance.
This and similar cases invite curiosity about the relationship between doctoring performance and the training through which all bona-fide physicians must pass: undergraduate pre-medical science courses, four years of medical school, and two to three years of internship and residency before they are considered trained for ordinary medical practice; specialization takes even longer. How, then, can it be that"doctors" lacking such training-there have not been many, but enough to establish a pattern-can nonetheless satisfy their patients, which, after all, isn't a bad test of medical performance?
The answer is that we have heavily gold-plated the medical-education system, so that, in terms of what most doctors do most of the time, their long and costly training is rarely relevant. This doesn't mean that open-heart surgery and other complex matters can be safely accommodated by a first-aid training course; nor does it mean that the prolonged and intensive training doesn't now and then pay off in the ability to detect or treat something beyond the skills of lesser-trained persons. But it does mean that the present medical-education system is akin to putting all bus drivers through astronaut training. Furthermore, since the entire medical system is organized around a marathon training program for the lowest level of entry, less-demanding alternatives-such as highly trained non-physician assistants-find it difficult to gain legal recognition, but even when they do, medicine's pecking order tends to limit their use.
Some measure of what really goes on in day-to-day general practice is to be found in a newly issued HEW report, "Health: United States, 1978," which notes that roughly half of all office visits are judged by physicians as "not serious." This finding, which dovetails with other inquiries into the subject, "may reflect," HEW states, "the substantial number of visits for preventive care, routine maintenance care and care for self-limiting conditions such as prenatal care, eye examinations and treatment for the common cold." In a large number of instances, including those involving the "not serious" category, patients were advised to schedule a follow-up visit.
In facing the public, the medical profession is naturally outraged by the suggestion of excessive training. But in medicine's internal politics, training and certification are issues that set groups of physicians against each other. The various specialty guilds, for example, insist that only those with specialty certification may perform certain procedures, but many uncertified physicians respond that their basic medical training makes them the best judge of their skills.
Meanwhile, the medical profession has astutely concluded that the phony-physician phenomenon calls for a tightening up of paperwork procedures. Okay. But the real doctors might also ponder why the fakes get such high marks from the customers.