Connecticut Medicine

Mar 2015

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volume 79, no. 3 181 REFLECTIONS ON MEDICINE A Neurosurgeon Remembers DANIEL E. NIJENSOHN, MD, MSc, PhD M y current interest in medicine lies primarily in the area of medical professionalism and in the ethics of neuroscience. In this article, I reflect mostly on my medical education and training, my practice of neurosurgery in connecticut, and my association with Yale University. Neurological surgery, a discipline of medi- cine and a specialty of surgery, is a serious occupation. As Michael Apuzzo remarked: "e gravity and concept of a life in neurosurgery is clearly in its own category of elite status. It is a life of involvement with the dramatic events of life and death and a terrible gray area in between, where lives are disrupted and emotional pain is intense. It is, by any measure, an extraordinary calling." 1 I arrived in Fairfield, together with my young family, in December of 1976. Greenfield Hill, where we eventually settled, looked enchanting. Unlike Mark Twain's Con- necticut Yankee, 2 the chimneys of the already decaying industrial buildings and factories of Bridgeport, the city where I would concentrate my active operative neurosurgi- cal practice, appeared to me as the towers of the fortress in camelot! From my perspective as a physician, I saw New Ha- ven in 1976 as the site of a world famous medical center because of Yale. Hartford enjoyed a national reputation thanks to Hartford Hospital and the University of con- necticut. Bridgeport acted as the regional power house in the wealthy Fairfield county because of Bridgeport Hospital and St. Vincent's Medical center. A third hospital in Bridgeport, Park city Hospital, eventually closed its doors. I joined a large neurosurgical group with active privileges in all the local hospitals. is allowed me to develop a large and diversified general neurosurgical practice. I operated on more than 9,000 documented cases throughout the years, including trauma, spine, pediatrics, tumors, cerebrovascular, stereotactic and functional, carotid artery, pituitary gland, skull base, peripheral nerve, and radiosurgery (I trained for that purpose at the Karolinska in Stockholm and worked with Alain deLotbiniere and Jonathan Knisely at the Yale Gamma Knife center in New Haven). In this present era of progressive subspecialization, my surgical volume and variety cannot be easily reproduced today. e active practice of neurosurgery is overwhelming. It is and should be patient centered. Ethical behavior is an absolute must. Every procedure should be carefully explained to the patient with particular emphasis on the risk-benefit ratio. I understand that surgical indications are variable, but I dislike those who call themselves "surgical cowboys" and take on excessive risk, thus acting to the detriment of their patient's well-being. Surgeons live with the memory of past complications and the fear of the ever present threat of a malpractice suit. e liability crisis in America affects high-risk specialties in a disproportionate manner, and without doubt, for any health care reform to succeed, it must include tort reform. e essence of medi- cal professionalism is placing dedication to the welfare of patients above the physician's personal or proprietary inter- ests. Increasing commercialization and perverse financial incentives threaten to convert medicine into a business. Unmanaged conflicts of interest, challenges to medical authority by insurance companies calling physicians just "providers," and the consumerism movement, have caused changes in medical professionalism that threaten our esteemed and old profession. I have enjoyed my association with neurosurgery at Yale University since my arrival in connecticut. I have known about Yale, neurosurgery, and Harvey cushing since medical school. cushing is the acknowledged founding father of modern neurosurgery. Born in 1869 in cleveland, Ohio, connecticut's Western Reserve, he studied college in New Haven, medical school at Har- vard, and became a surgeon at Hopkins under Halstead. In 1912, he was recruited to a new hospital in Boston, the Peter Bent Brigham, to be its surgeon-in-chief and Harvard professor. It was there that he singlehandedly developed neurosurgery as we know it today. Boston did not treat cushing well on his retirement in 1932. He re- turned to Yale University, appointed as the Sterling Pro- DANIEL E. NIJENSOHN, MD, MSc, PhD, Honorary Professor, Department of Neurosurgery, Yale University School of Medicine, New Haven, Emeritus chief of Neurosurgery, St. Vincent's Medical center, Bridgeport, Honorary Staff, Bridgeport Hospital, Bridgeport, Former Staff, Yale New Haven Hospital and Yale Gamma Knife center, New Haven

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