My grandfather was a psychiatrist from the 50’s through the 90s. My mom was a pediatrician, then a dermatologist from the 80s through the 2010s. Bet

Trevor Klee’s Newsletter

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2022-07-04 23:30:02

My grandfather was a psychiatrist from the 50’s through the 90s. My mom was a pediatrician, then a dermatologist from the 80s through the 2010s. Between the two of them, I’ve gotten a good sense of the way medicine has shifted through the last 70 years or so: the rise of the FDA, the growth of modern pharmaceuticals, the domination of the “fee-for-service” model, the increasing influence of the insurance companies, and, more recently, the pernicious influence of electronic medical records.

One of the things I noticed talking to my grandfather while he was still alive and my mom now is the way in which their medical thinking was influenced by the structure of the medical establishment while they were being trained. My grandfather, trained in an era before strong FDA regulation of medications, was mostly distrustful of medications. He much preferred talk therapy and psychoanalysis, seeing medications as a last resort when those failed. He was very conversant in the studies themselves, though, constantly reading journals to see the latest advances in pharmaceuticals.

Meanwhile, my mom was trained in an era before prior authorizations and the fear of malpractice suits were quite so pervasive. So my mom has always been very comfortable prescribing a variety of medications both on and off-label depending on her patients’ needs. She felt confident in her ability to help her patients navigate side effects when or if they experienced them.