I am decorating a new medical clinic. It is kind of exciting.
After spending most of my life practicing medicine in drab government hospitals, I feel liberated. Along with a couple diplomas, and family pictures, I decided to bring in some Norman Rockwell reproductions. A mid-20th century American artist, Rockwell, who lived from 1894 until 1978, depicted medical encounters that are deeply imbedded in the small-town America of the Great Depression era.
One image depicts an elderly doctor sitting on a rickety chair, writing a prescription. His stethoscope hangs in front of a worn tweed coat. He looks weary. A young woman watches, her children sitting attentively on her lap, as the encounter unfolds. A second painting reveals another physician taking the pulse of a toy doll, as a little girl watches. A third painting reveals a distinguished physician in a light brown suit struggling to read a thermometer. A pre-teen boy peers at the instrument, clasping the doctor’s shoulder from behind.
Aside from reflecting outstanding technical artistry, these paintings depict a world gone by. Rockwell’s physicians, for example, made house calls. Yet they often had little to offer in terms of treatments. For example, antibiotics only came on the scene just before World War II.
Tuberculosis medications only emerged in the 1950s, along with the Salk vaccine for preventing poliomyelitis. Treatments for mental illness were limited, as anti-psychotic medications only took off with the development of chlorpromazine in the 1950s. Why then, did these small town doctors appear to be so respected and loved?
For one thing, there is more to medicine than curing disease. For example, the doctors of Rockwell’s communities could comfort the ill and dying, prescribe analgesics, and reassure anxious families regarding the natural history of self-limiting diseases, like chicken pox or measles. Also, they could incise and drain abscesses, set broken bones and deliver babies. Indeed, medical care was more sophisticated in the early 20th century than ever before.
The real thing Rockwell describes, however, is the solidity and importance of relationships that are imbedded in a sense of community. These physicians probably were middle-class, and lived in the same communities as their patients. There was little separating the doctor from the patients.
Litigation was less common, as well. Consequently, a doctor had time to gaze at a thermometer with a kid, or take a doll’s pulse. Today, that doctor would likely be deeply immersed in documenting his “electronic medical record,” in order to prevent lawsuits. Since most patients paid for services directly, both patients and doctors were invested in maintaining harmonious relationships. Most doctors were generalists, so the vast majority of care was provided by a single human being. Doctors tended to care for the same patients when they were admitted to the hospital, rather than signing them off to “hospitalists.” From birth to death, therefore, families saw the same face peering at them in the bedroom, examining room or hospital ward.
This nostalgia-fest probably needs a reality check. I personally would not like to go back to the days before MRIs, chemotherapy and organ transplantation. Moreover, the Rockwell universe did not reflect the presence of women in medicine. Minorities were also largely absent, although Rockwell did paint scenes of the civil rights movement in subsequent decades.
Rockwell’s America represents a series of subjective snapshots of our national past, frozen in time.
Every generation creates its own artistic narrative and tapestries. Maybe a young person observing clinics and hospitals today will create art work reflecting the relationships that lend meaning to those contemporary experiences.I guess we will have to wait and see. In the meantime, I’ll gaze at my old Norman Rockwell prints.
Scott T Anderson, MD (email firstname.lastname@example.org), is Clinical Professor at UC Davis Medical School. This Article is informational, and does not constitute medical advice.