Self Diagnosis

The ceremonial speeches at medical conventions are usually sugared pills of platitudes. But in San Francisco last week, at the 29th annual meeting of the American College of Physicians, it was different. Doctors took a sharp look at themselves and disapproved of some things they saw.

Dr. Alan Gregg of the Rockefeller Foundation stuck a probe into the powerful specialty boards,* which certify doctors as specialists in the 15 recognized fields. The inbred, backward-looking boards, he said, give examinations that try to find out whether a candidate knows what the examiners know, not what the candidate himself knows; they stifle medical progress by "withholding approval of the new by insistent emphasis on expert knowledge of the old"; they become "partners of static and reactionary, albeit powerful and respectable, inertia or ignorance." Dr. Gregg's suggestion: pick specialists by their competence in practice.

Retiring A.C.P. President Hugh J. Morgan, of Nashville, Tenn., gave the 2,500 physicians a gloomy going-away present. He reminded his hearers of Cicero's high opinion of physicians ("In nothing do men more nearly approach the gods than in giving health to men"). But now, he said, physicians are losing the public's respect by commercialization--a tendency that has increased over the past 25 years.

Medicine's frantic search for a single diagnosis of every case, said Psychiatrist Karl Menninger, turns bacteria into demons and medicine into a demoniac science. Physicians, he said, should think of disease "in terms of the total economics of the personality."

Physicians have failed to find a satisfactory way of permanently curing peptic (stomach) ulcers, said the University of California's Theodore Althausen. The standard treatment (bland diet) temporarily cures 90% of the cases; but 10% to 36% develop ulcers again within six months after the "cure," from 46% to 93% within five years.

* A.C.P.'s membership includes doctors who specialize in internal medicine and allied fields, but not surgeons; the American Medical Association, no rival, and the A.C.P. cooperate to sponsor the specialty board in internal medicine.

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