In Marion County, patients still come first

I recently reread a famous 1948 LIFE Magazine photo essay by W. Eugene Smith entitled “Country Doctor.” The essay is about Dr. Ernest Ceriani, a 32 year-old general practitioner in Kremmling, Colo., a town of 1,000 residents about 115 miles west of Denver.

The remarkable images were taken over the month that Smith spent following Ceriani. The beauty of the pictures is that they not only capture his work-delivering babies, suturing wounds, counseling patients, but they also bear witness, better than anything I’ve ever seen or read, to what it means to be a doctor. The most moving image shows Ceriani transporting a patient to surgery in the town’s tiny hospital. He has lifted his frail, elderly charge off the bed and is carrying him as a shepherd might cradle a lamb.

Ceriani, like many physicians in Marion County, could have earned more in a larger city, but he chose to put service to patients above enriching himself.

As the LIFE article puts it, “Ceriani is compensated by the affection of his patients and neighbors, by the high place he has earned in his community… For him this is enough. The fate of thousands of communities like Kremmling in dire need of “country doctors,” depends on whether the nation’s 22,000 medical students also think it is enough.”

Marion County is fortunate to remain a place where medicine is more a calling than a business. The ethic in this county still resembles that of Kremmling in 1948.

Although much has changed for the better in medicine in the past 51 years, one disturbing trend has been the rise of the profit motive. In Ceriani’s day, investor-owned, for-profit hospitals did not exist. Today, for-profit hospitals and insurance companies set the tone in many medical communities. For a current perspective on the increasing influence of money, I’d recommend “The Cost Conundrum,” an article in the current issue of the New Yorker by Atul Gawande, a Massachusetts surgeon.

He describes a visit to McAllen, Texas, a border town that is one of the most expensive health-care markets in the country. Despite Medicare spending that is twice the national average, patients in McAllen enjoy health care quality no better than cities with far lower costs.

In a radio interview with Gawande that I heard recently, he attributes much of McAllen’s trouble to overutilization: overuse of imaging studies, procedures and surgeries. One of the explanations that he offers is “the culture of money.”

In McAllen, too many doctors have let the prospect of financial gain overwhelm their sacred obligation to patients. In Marion County, we are fortunate to have a medical culture still based on what’s best for our patients.

We have a non-profit hospital that belongs to the people of this county and has solid local governance. We have a close-knit community in which many of our doctors, physician assistants, nurses and other medical personnel are active members. But I suspect the most important reason that we have a patient-centered culture in this county is the leadership of the senior members of our medical community.

Space constrains me from listing them all, but I want to highlight one of those exemplary doctors. Dr. Jim Suggs, by his practice of medicine and his love of his fellow man, provides us with our moral compass. Suggs trained in an era when the care of the patient was a physician’s top priority: house calls were common, as were frequent late-night trips to the emergency room.

He and other physicians of his generation often endured tremendous personal and professional strain on behalf of their patients; that strain, a mix of worry and compassion, is conveyed magnificently in the LIFE photos.

The good news for Marion County patients is that because of medical professionals like Suggs and the colleagues that emulate him, you still come first.
Reach Dr. DeMarco at pvdemarco@bellsouth.net. View the LIFE photos at http://images.google.com/images?hl=en&q=source:life+ceriani&sa=N&start=21&ndsp=21