Quality, Not Quantity Needed

Lapius had warned me that morning that Dean Cator would probably be at the house when I got home.

“You don’t mean Edward Ullrich Cator the famous educator?” I feigned awe.

“Of course.  One and the same, Harry.  He is interested in my ideas about medical education.”

“Really?”

“Not really,” said Lapius.  “That is merely his approach when he wants to solicit donations to support his three year course for bright students at the medical school.”

“And you donate to that folderol?” I asked with astonishment.

“Certainly.  I donate my ideas on medical education,” said S.Q. Lapius.

Dean Cator was indeed an imposing man.  When I entered he was half defrocked, and already under the influence of some Lapius imbibe-ments.  He sat in vest and shirtsleeves with a gold chain strung in two neat catenary curves between pockets on either side of his vest.  His bald head shone even in the dim lighting, like the skin of figures at was-works.

When I entered he bestirred himself to grasp my hand in both of his, and fondle it gently.

“Harry, so good to see you again.  How well I remember you as one of my best students.”  Since I had graduated somewhere in the middle of the class, the dean’s memory was mind-boggling and I figured he was trying to hit me up for a donation too.

“But why the three year course in medical school?” Lapius inquired.

“Simple, Simon,” the dean said, while Lapius shuddered at the juxtaposition of those words.  “The country needs more doctors.  Therefore if we turn out a class every three years instead of every four, ergo, about a 30 percent increase in the number of doctors available.”

“But aren’t they a little young, Dean?” Lapius asked.  “I understand that the medical school curriculum is combined with only two years of college.”

“Quite true,” said the dean urbanely.  “I spent a lot of time working out the curriculum.  The nation must be served, Simon, and I take pride in my role of creating the number of doctors we are going to need.”

“Perhaps you will increase the number of individuals who have M.D. degrees, dean, but you won’t necessarily increase the number of doctors.”

“How so?” the dean appeared bewildered.

“Because there is an element of maturity required of those asked to assume the responsibility of a physician.  One purpose of four years in college and then four years in medical school and then four or five years in training, is to allow time for children to grow up.  It seems to me you are pruning the youth before they ripen enough to bear fruit.”

The dean didn’t care for the turn in the conversation, and took the moment to refill his glass with the tacky cherry liqueur that Lapius had served.

“But surely, Simon, they will have plenty of time to grow up after they have finished medical school and the prerequisite training, which, incidentally, I am trying to reduce to two years.”

“Well, maybe you are right, Dean.  Perhaps three years is all that is needed.  The kids today are so bright.  But I must say, that since I graduated, even since Harry left school, the science of medicine has grown so fantastically that I would, were I the dean, increase the requisite years to six instead of reducing them to three.  The basic sciences alone should take three years, which would allow no time for clinical training.”

“Simply look at the progress that has been made in the study of fluid balance, electrolytes, blood gases, inhalation therapy, biochemistry; to say nothing of the literally hundreds of new therapeutic regimens that have been introduced.  Even the expanded use of aspirin and the biochemical basis of its interactions is probably worth a month of study alone. How can all that be compressed into three years, and don’t forget kidney dialysis, the new advances in cardiology – my goodness, I have had to spend a lifetime learning things I would have been glad to have learned in medical school.  I have often remarked to Harry that I was sorry to have been born too early and to have missed the marvelous educational opportunity offered to present day students, haven’t I Harry?”

“Yes indeed you have, Simon,” I agreed hurriedly.

“So you see, Dean,” Lapius continued, “there can be no way that the curriculum can be compressed to three years and still turn out doctors.”

“Ah, Simon, but you are wrong.  We do that by simply cutting the fat out of the curriculum.”

“What fat,” Lapius owl-eyed, asked incredulously? 

“The specialties.  We exclude studies in ear, nose and throat, ophthalmology, urology and dermatology, to list a few.  That way the student doesn’t have to be encumbered with information he won’t need unless he decides to go into one of those specialties.  Then he can pick up the information in his residency training.”

“My God,” Lapius exclaimed in horror, “You’ve dissected the human body before the student even gets into the anatomy room--.”

“Oh yes we have excluded that too.  He can pick anatomy up in surgical residency.”

“The curriculum at the school for practical nursing is more comprehensive, Dean.  You are graduating a generation of imposters, not doctors.  Medical education should not be degraded, but uplifted.”

“But the under-privileged lack medical care, Lapius,” the dean said tartly.

“Perhaps, but that is a condition that will hardly be corrected by your misguided educational values.”

“Then I take it you won’t donate.”

“Of course not.  I shan’t participate in a plan that so diminishes a great profession.”

Cator flung his coat over his shoulders like a cape and left in a Huff, (a small economy car).

“I think you made him angry,” I remarked.

“I hope so,” said Lapius.  “If doctors won’t protect the great profession of medicine, who will?”

“Maybe the public?”

“Perhaps,” said Lapius morosely, “but a few generations will pass before they learn they have been misled.”