How Doctors Are Made

After Stafford Leake Warren's family moved from New Mexico to Hayward, Calif, in 1899, young Staff used to run errands for the town drugstore. This emporium still stocked leeches and bleeding cups for one of the local doctors, a spry oldster who had never gone to medical school. Half a century and a couple of medical revolutions later, Dean Stafford Warren of the University of California School of Medicine at Los Angeles looked on pridefully on Graduation Day as the 33 men and three women of his second graduating class won the right to put the cherished initials M.D. after their names.

The modest crop from U.C.L.A.'s burgeoning med school was a welcome addition to the estimated 7,000 new doctors just graduated from the nation's 75 accredited four-year medical colleges. As products of the nation's shiniest new med school, designed from the first to profit from the mistakes and experiences of others, the 36 young doctors from U.C.L.A. could boast of the most modern medical education possible.

Friendly Paw. When U.C.L.A. set out in 1946 to build a new school from the ground up, it tapped Stafford Warren, a great bear of a man (6 ft. 4 in., 210 Ibs.) with a disarmingly friendly right paw. He had completed 20 years on the faculty of the University of Rochester Medical School, had spent three years as health guardian of the people involved in atomic-energy work from Los Alamos to Bikini.

Warren and the faculty that he began to assemble took three years to decide on a curriculum. They culled the teaching techniques of their own old schools and others, paying special attention to those schools that were getting to be known as innovators. Outstanding among them: Cleveland's Western Reserve University. Warren & Co. followed Western Reserve's lead in switching away from what is called the "block system," prevalent in conventional medical schools. Under this system, the student starts with anatomy and keeps on studying it through his first year without regard to its specific meaning in terms of patients' health. After anatomy come physiology and pathology--each important subject taken up without relation to the other.

U.C.L.A. decided to teach everything at once, or nearly so. As a result, its medical freshmen spend their first year learning only about normal man--his psychological and biological aspects in terms of structure, function, growth, behavior, the effects of environment. At every step anatomy, physiology and biochemistry are correlated. The next 18 months deal with disease. The last terms include full-time bedside and clinic experience.

It is a rugged course and the student has to devour his books, but he need never sweat his grades because at U.C.L.A. med school there are none. If a man is doing badly, a faculty member will advise him. If he wonders how he is getting along, he has only to ask a prof, who will find out and tell him. Under U.C.L.A.'s system, only one student has been flunked, out of the first 196 enrolled.

Eliminate Mechanics? U.C.L.A.'s Warren is proud of these changes in teaching. "When a young man enters this medical school, he buys a stethoscope the first day," he says. "We teach him a lot of things that weren't taught 15 or 20 years ago. Those men of past years were laboratory doctors: every doctor was a scientist and he carried science from the laboratory to the patient's bedside. Now we are going back to the bedside as human beings.

"There are three basic types of doctors coming out of U.S. medical schools: the healer, the scientist and the mechanic. We are looking for the healer and the scientist. Sometimes we get both in one package, and that is fine, but we are content if we have one or the other. We'd like to eliminate the mechanic, but let's face it: he does get into medical schools and he does get through them. When he gets out he usually drives a big car, has enormous prestige in his community and is usually rated as a successful man. We don't know just what it is that makes the healer. It is some sort of magnetism--the sort of thing that makes a patient respond as soon as the physician comes into the room or touches him."

It might be thought that the sheer volume of medical knowledge, which has increased with the speed of multiplying bacteria, would be a crushing burden in the training of doctors. Not so, says Staff Warren. "Medicine, although more complicated now than ever before, is actually easier to teach. A good school can still turn out a satisfactory, all-round physician in four years. We can teach more to a student today because we know more and can give more reasons for things. We have better teaching aids and better facilities. I can remember in my own days in med school when a lot of us were trying to listen to the heartbeat and couldn't be sure we were hearing what we were supposed to hear. Now, with electronic devices, a whole class or school--or most of West Los Angeles--can listen to a heartbeat if necessary. And they can hear it clearly and it can be clearly explained."

Chrome-Plated G.P.s. Despite Warren's emphasis on the all-round physician, most of his students will wind up as specialists. This is a serious problem. Some parts of the U.S. (especially the Southeast and the Mountain States) simply have not enough doctors of any kind. Southern California has or soon will have enough--but too many of them, proportionately, are specialists. Yet 77% of U.C.L.A.'s first two graduating classes have announced their intention of going into one of the 28 recognized specialties (from allergy to urology), many of them to become internists (sort of chrome-plated general practitioners who make a big thing of diagnosis but stop short of obstetrics and surgery). Fred George Smith Jr., who graduated last year in U.C.L.A.'s first medical class, is now finishing a pediatric internship at U.C.L.A. Medical Center Hospital. Says Smith, who plans to specialize: "The trend toward specialization is getting stronger despite all the efforts to get men into general practice. It isn't because most of the fellows think there is more money or prestige in specializing. But practically all the men feel that the body of medicine has become too big and complicated for any one man."

One who disagrees with Smith is Dr. Thomas Richard Early, 30, another member of U.C.L.A.'s first graduating class. Early is just finishing a fruitful year of internship at San Diego Naval Hospital, during which he has worked up to 105 hours a week, delivered 50 babies, done 23 hernia operations, snipped 21 appendices and twelve sets of tonsils--altogether 178 operations under supervision of a senior doctor. Early, a down-to-earth son of a South Dakota wheat farmer, has no interest in specializing, feels that good medicine depends on knowing the patients and that the best way to know them is to treat them for everything that ails them--up to the limits of his knowledge.

Says Early: "There's no reason for a doctor to send Johnny off to a pediatrician to have a boil lanced or a sliver removed, just because Johnny is under twelve. Yet an internist is supposed, ethically, to send all patients under twelve to pediatricians. There's no reason why a general practitioner can't do most minor surgery and most obstetrics. If there's anything unusual about a case he'll call in a specialist anyhow." General Practitioner Early starts practice this week in Lemon Grove (pop. 20,000), nine miles from San Diego, in partnership with an older doctor.

He will find, like any doctor worth his pills, that his medical education is just beginning. Says Teacher Warren: "One of my pals among the medical deans likes to say: 'What we are interested in is the 40-year education process--having a doctor go on learning all his active life, from his patients, his fellows and from graduate courses--not just four years of medical schooling.' And I agree with him."

This file is automatically generated by a robot program, so reader's discretion is required.