I’ve never met him, but Dr. Bernard Lown is a hero in my family. About three decades ago, my father had some heart disease trouble, and was told he’d need open-heart surgery. Instead, he consulted with The Lown Center, named for its founder, the Nobel-peace-prize-winning physician Bernard Lown. Its less-scalpel-happy heart experts advised him to try lifestyle changes instead. A full generation later — and it’s quite literally a generation, because he has lived to enjoy much-loved grandchildren — my father is a Lown poster child, preternaturally young for his 85 years, eating (mostly) healthily and still working out every day. (Knock knock knock on wood.)
So when Dr. Lown speaks, I gratefully listen — and I was heartbroken to miss his speech at last week’s Avoidable Care conference in Cambridge. (Read Dr. Vikas Saini’s concise wrap-up here.) Fortunately, Dr. Lown is a nonagenarian blogger, and has posted his speech in full, titled “Social Responsibility of Physicians.” It’s full of big ideas about how doctors should treat patients, and little gems. It begins:
Ever since starting clinical practice 62 years ago I have looked forward to this conference. Mercifully, good fortune and good genes enable me to attend. From my earliest days in medicine I have struggled against the prevailing model of healthcare. My opposition in part was provoked by the growing prevalence of overtreatment. Resort to excessive interventions seemed to be the illegitimate child of technology in the age of market medicine. If more than a half century ago overtreatment was at a trickle pace, it is now at flood tide.
Reflecting back on early days, the first overtreatment I encountered was not related to technology. It involved keeping patients with acute MI’s at strict bed rest for 4 to 6 weeks. This was a form of medieval torture. It promoted depression, bed sores, intractable constipation, phlebitis, lethal pulmonary embolism and much else. Worse it augmented cardiac ischemia and predisposed to malignant arrhythmias. Physicians were aware of what was transpiring but felt it was necessary to protect patients against cardiac rupture which activity may provoke.
The great Brigham clinician, SA Levine, my teacher and mentor, believed that patients would fare better when nursed in comfortable chairs. Yet he was not ready to challenge established practice. With his backing I launched such a study in 1951. The house staff initially was vehemently opposed, even greeting me with Sig Heil Hitler salutes. Soon they became avid supporters.
In a comment on Dr. Lown’s blog, a reader sums it up nicely:
Warren Green | April 29, 2012 at 4:41 pm |
A remarkably cogent, lucid, magisterial piece. I only wish we were there to see and hear you deliver it. My favorite line: “We did much for the patient and as little as possible to the patient.”