Paul Teplis, MD
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Teplis P. My First Fee. Ann Intern Med. 2001;134:531. doi: 10.7326/0003-4819-134-6-200103200-00023
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Published: Ann Intern Med. 2001;134(6):531.
It was the summer of 1946, and I was in my senior year of medical school, going through my rotations on the way to becoming a doctor. The hard work had taken away some of the desire and idealism of becoming a doctor. But I had already come this far. Only a few more months to go and I would achieve my first major goal in life. I was assigned to the medical clinic in “Colored” Grady Hospital in Atlanta, Georgia. (“White” Grady was located across the street; segregation was de rigueur at the time). My job was to examine a patient and then present my findings to the attending physician and suggest a course of action. As always, we were pressed for time.
My patient was brought in to the examining room, where I took a history. The patient was a young black pregnant woman who had been referred to the medical clinic by the obstetrics department for evaluation of a heart murmur. Here I was—a consultant before I had even received my medical degree. It wasn't until years later that I realized the seriousness of my task—being entrusted with the welfare of two lives. After taking a history, I proceeded to examine the patient. By that time, the attending physician had arrived, and I presented the case to him. Time has dimmed my memory as to what procedures we decided upon to evaluate her murmur. Certainly we didn't have much technology at our disposal. I think that electrocardiograms were three leads at that time. Chest x-rays were available, and a cardiac series consisted of posteroanterior, lateral, and two oblique views. The oblique views were done after a barium swallow to follow the contour of the left atrium. Echocardiograms, cardiac catheterization, and sound tracings of heart sounds and murmurs were all nonexistent. If I wanted a CBC, I took out my personal lab kit and did it myself. If I wanted a urinalysis, I did it myself. Laboratory services were meager and hard to get. As I look back on those times, compared to today, medicine was really primitive from a technology standpoint.
Despite the lack of technology, medicine was practiced as it always has been—with a true desire to help people; and the patients felt it and responded in kind. The attending physician at Grady Hospital and I did whatever we thought was necessary to evaluate this young woman's murmur, and we came to the conclusion that the murmur was not significant and would not be a problem in her pregnancy. The patient returned to the clinic in 1 week to get her results. She came with her mother, and both of them were quite anxious to find out what fate had in store for her. I told the young woman the good news. The look of relief and happiness on both of their faces is still vivid in my mind. Before leaving the room, the mother opened her purse, took out 50 cents, and pressed it into my hand. In 1947, 50 cents to a Grady clinic patient was, indeed, a lot of money. It was a lot of money to me, too. I tried to return it to the mother but she refused. If I had insisted that they take back the money, I believe that the patient and her mother would have been insulted. They left the clinic ecstatic. I never saw or heard from my patient again.
Paul Teplis, MD
Marietta, GA 30068-4506
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