The Lost Art of Doctoring

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Jason Edwards / National Geographic via Getty Images

The baby was just not coming out. Not a very big problem — not in a birthing room in a world-famous obstetric hospital, where nurses, midwives and aides, and doctors, lots of them, were packed in cheek-by-jowl. The major problem I had with this reluctant baby was that she was mine.

My young wife was in no mood to have her abdomen sliced open and, I think, even less inclined to accept whatever bizarre version of personal defeat comes with the failure to sufficiently “Push, push, push!” as the chorus of earnest attendants had been cheering for hours. Nor did it help being the wife of an orthopedic senior resident during those adolescent days of the women’s movement (22 years ago), when just about everyone we knew who had ever held a retractor (i.e., all my friends) felt just fine strolling in, saying, Hi, and shooting the breeze — with my wife on her back, in, you know, labor.

Dr. B was old school. A full professor of OB-GYN. He did the high-risk OB cases, took care of all the residents’ wives, was a little eccentric, utterly devoted. Everyone loved him. He’d rounded on my laboring sweetheart every few hours, head tipped back a little as he gently examined her, looking blankly into the middle distance, seeing with his hands. But this was now his fifth or sixth round.

“It’s time to take that baby out.” He said it so cheerily that it was a few seconds before she shot me the worried glance: Surgery? But there was no indication that he was getting ready for a caesarean.

Dr. B said something about “Haig” to the nurse in charge. She came back with a big, green-wrapped sterile instrument pack: Haig-Douglas forceps (no relation). They were curvy metal, somewhat like salad tongs, two parts he hooked together so adroitly. He dipped them in some pink solution, then in three seconds, he twirled them just so, around my not-yet-born daughter’s crowning, stuck little head.

“Here we go,” he said. Then a good pull — not quite an orthopedic pull, but a pretty damn good one considering he was pulling on my 7-lb. baby’s neck — and a slip and a slosh, and there she was, black eyes wide open, good as gold, without a scratch.

And that was that. No operation, no anesthesia, no retractors, no bleeders, no sutures, no pain meds, no scar. What wonderful things forceps were that day. And how wonderful that it was 1988 and we had Dr. B, because nobody else even knows how to use forceps any more.

My wife and daughter were among the last Americans to benefit from forceps delivery — one of medicine’s lost arts. They hardly use forceps anymore in this country. There are a host of reasons why not, but I’ll bet you can think of them: malpractice suits; the financial boon that is a C-section; the intrinsic difficulty of teaching residents how to use them. Only one set of hands can be on the tool at a time, you know, and with Dad in there watching the birth these days, whose do you think he wants holding them, the professor’s or the student’s? (Being the Dad will drive that lesson home.)

One of the (few) great things about being a surgeon in your 50s is that back when we were in training, they still opened people up high, wide and handsome. We passed our hands over the smooth domes of livers, felt all over our patients’ insides for things that younger surgeons, who learn and do most everything laparoscopically, only see on a TV screen.

We were taught to talk more to our patients, to look at them, feel them, even smell them in order to figure out what was wrong. (I did refuse to taste test urine, however; test strips have been around since the ’60s.)

Young physicians still talk — but mostly to make patients feel good. They still do a bit of an exam, but mostly to be able to fill out a computerized form. A barely noticed revolution has gone on in medicine during these past 30 years. Diagnosis is no longer seen as something doctors do. It’s now the result of the tests they order. Insurance companies and hospitals like this. But even the hippest docs, when they care, don’t truly believe it.

Start droning on about the “lost art of the physical exam,” and young Dr. Sharp invariably nods out; he takes objective, evidence-based studies, MRIs, CTs and blood tests over an old codger’s humanistic voodoo any day.

But when the young doc can’t sleep all night because his shoulder’s been hurting, he pulls me into the stairwell and says, “Scott, hey, do me a favor and feel this.”

The lost art of the surgeon often involved less surgery. Orthopedics used to mean being good at getting broken bones to go back where they belonged, with so many plasters, splints and braces. Today we typically just get a scan and book the surgery. Now, don’t be fooled by this: the operations weren’t as good or as safe, back when. If my daughter had ended up with a crease in her head from those tongs, I’m sure I wouldn’t be so nostalgic either.

But there are still folk who just don’t want to be cut open (surprisingly many doctors among them). Convincing them to have surgery, no matter what the scans say, remains a fully humanistic, non-computerized operation. These cowardly patients among us might just be saving American medicine.

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