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TV REVIEW : Patients Take Control in 'Medicine at Crossroads'

April 05, 1993|ROBERT KOEHLER | SPECIAL TO THE TIMES

When an American doctor in the wide-ranging WNET-BBC co-production "Medicine at the Crossroads" describes physician-patient relations as a "Beirut" situation, you have to wonder if the doctor's defensiveness isn't getting the better of him. But if you follow this four-week, eight-part series as it explores and confronts long-held medical assumptions, the doctor's opinion becomes clearer. The congregation--that is, the public--that once attended to every word of the high priests of medicine are questioning authority, and the questions have the whiff of a revolution about them.

The series begins at 9 p.m. on KCET Channel 28, and at 8 p.m. on KPBS Channel 15 and KVCR Channel 24. It continues on Mondays through April 26, with two one-hour segments during each evening.

With medical wisdom queried as never before, it's appropriate that the series begin with a segment titled, "Temple of Science," which profiles Johns Hopkins hospital in East Baltimore, the preeminent teaching hospital in the United States. What's surprising is that much of the questioning at Johns Hopkins is being asked by doctors, who openly speak to the camera about their doubts and fears of the methods and results of medical training.

Internist Dr. Alicia Fry, slogging through a 36-hour shift and juggling 40 patients, says that "it's very tiring . . . you get bitter." She explains that emergency care patients, often crime victims, are called "hits," as in warfare. If this distorts a patient's humanity, then the teaching hospitals' focus on extreme, intensive care of the worst cases "distorts the picture of medicine," according to Dr. Kerr White, formerly of Johns Hopkins. Ninety percent of a doctor's typical caseload, says White, will be more everyday sickness. The Johns Hopkins war zone doesn't prepare physicians for the real world.

Out on the street is Rev. Melvin B. Tuggle, an East Baltimore Baptist minister who is an exemplar of the series' dominant practical message: Prevent ailments today and you prevent emergencies tomorrow. Importantly, the medical clinic Rev. Tuggle has set up in his church on Sundays is coordinated with Johns Hopkins aides. It is the closest thing in an American community to a family doctor making house calls.

The lack of an intimate history between a doctor and a family forged by the house-call tradition is partly why doctor-patient distrust now runs deep, as depicted in the second hour, "Code of Silence." The ancient medical notion of not telling the patient all of the bad news is based on the equally ancient truism that what you don't know can't hurt you. It is more entrenched, according to this report, in Japan than in the United States, but in both countries, the notion of a patient's beneficial ignorance is being overturned.

The American movement for patient involvement in treatment and in open discussions of medical options is being led by AIDS activists, whose demands for honest diagnoses have opened the door for people with other ailments. The report shows the Japanese fight against the code of silence in the starkest way: As a way of explaining a loved one's breast cancer, a doctor brings the excised breast into a room where the family has met. It's one of several brutally honest moments in "Medicine at the Crossroads" not for the squeamish; still, the seriousness of breast cancer has perhaps never been so openly explored on television.

If "Medicine at the Crossroads" misses a valuable theme, it is the social causes for the new questioning of medical authority. Subsequent segments include "Life Support" (dealing with long-term and elderly care in the United States, Ireland and India), "Conceiving the Future" (on the ethical stakes of gene research and concerns about eugenics) and "Random Cuts" (on new doubts about the need for surgery). That it's a heart specialist--Dr. Caldwell Esselstyn--leading a group of patients on a course in low-fat, low-cholesterol nutrition is as positive a sign as the series offers that the temple of medicine may be starting to change its ways.

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