VISITING THE HMHC
Our permanent collections are operated by the Hennepin Health Foundation.
The collections are located in the lower level of the HCMC Blue Building – 915 S 8th St, Minneapolis, MN. MAP
Both collections are open:
Tuesdays and Thursdays
10am - 2pm and by appointment
The MMC Collection:
Is located in BL.227.
The HCMC Collection:
Is located in BL.226.
Email | 612.873.6090
"My time at HCMC..."
The website blog offers reflections and experiences by current and former HCMC employees and staff members about their work and careers at the Medical Center. The interviews were conducted and edited by Iric Nathanson and Thomas R. Mattison.
To check out previous blogs, click here.
November 14, 2013
Dr. Michael Belzer is Chief Medical Officer at the Hennepin County Medical Center
This is his story:
My father was a physician but his practice was quite different from medical practice today. When I was in high school in the 1960s, I remember travelling with him on house calls. He had the classic black bag with a stethoscope, antibiotics and a whole kit of things to deal with emergencies.
Back then, emergency room medicine was not a specialty. If one of my father’s patients had an immediate medical problem, that patient would go to the emergency room at Fairview Hospital and be seen by the physician on call, often a resident. More likely than not, my father would drive to the hospital and see the patient.
My father would never have had a nurse return a phone call. That was unheard of back then. Today, if you call a clinic you will get a return call from a clerical person or maybe a nurse.
Then, my father would make all the phone calls himself. At the end of the day, he had a long list of people to call, and he would work his way down the list. There were no pagers, so it wasn’t always easy to connect with your doctor.
There were also in-kind payments. This was the time before federal support for health care—before Medicare and Medicaid. Either you had private insurance or you paid in cash. And if you didn’t have money, you might pay with whatever you had—groceries, liquor, knitted sweaters.
Then, physicians like my father would begin their day by driving to the hospital. They would meet with their colleagues in the doctors’ lounge, begin their rounds and start writing orders. They would finish their rounds and drive back to the clinic or to their office, where they would spend the afternoon seeing patients. At the end of the day, they would drive back to the hospital, admit patients and write more orders. It was a long day. Often 10, 11 or even 12 hours.
Now, there is a growing practice of hospitalists—physicians who spend all their time in the hospital. Today, many internists and family practitioners have very little contact with hospitals. There is getting to be a dramatic separation between ambulatory and hospital care.
My early experience was quite different from that of my father. After medical school, I did a three-year residency in Chapel Hill, North Carolina, and then a three-year fellowship in hematology-oncology at UCLA medical center in Los Angeles.
When I came back to Minneapolis, I went to work here at HCMC. My job as a hematology-oncology specialist was to provide clinic as well as in-hospital care. That work would have been very different if I had been out in Edina or Wayzata, rather than here at a large safety net hospital. Out there, if I told someone that they had breast cancer or lung cancer, the patient would probably be distraught. They would never get past the word “cancer.” They would want a second opinion. Here it was very different. If I told one of my patients that they had a terminal illness, the response often was “OK. So what’s next?”
For people who have had very difficult lives, the emotional impact is very interesting when you tell them they are going to die. It took a different skill on my part as an oncologist to deal with that. When I got into this field, I understood that I would be dealing with terminally ill patients. Probably, the most important role of an oncologist is to manage deaths.
If you don’t do it right, you have damaged family members for the rest of their lives. If I had 15 people who cared about their terminally ill loved one, those people were every bit as important as the patient. I was going to make sure that the patient was as comfortable as possible. I also needed to make sure that the 15 people accepted the situation and understood what was happening with their family member. If I didn’t handle the situation properly, they were going to be angry at the physician, at the medical center and at the whole field of medicine.
I had to figure out for myself how I was to do cancer work-oncology—and do it well. There are lots of ways to do it poorly—talking to the patient on the fly—not really listening. But I wasn’t going to do that. When I met with a patient, I had a virtual script. I would sit down and ask the patient: “Please tell me what you understand about your disease.” I wanted to make sure I knew what they did and they did not understand, so I would not be talking over their heads. Then, I would ask them if they had questions. But the most important thing was to make sure I had enough time to spend with the patient and their family. There is nothing worse than rushing through all of this. Some practitioners do that because the situation is uncomfortable and they want to get out of that situation as soon as possible. But that is not what good care is all about.
I was a medical student when the old General was still in use, but the new hospital had already been built when I came here as a resident in 1980. There was definitely a special aura, a culture and a feeling to the old hospital.
Under the medical leaders of that earlier era—men like Claude Hitchcock, Dick Raile and Al Schultz—it was clear that you were not at the University Hospital, at the VA or at one of the private hospitals.
This hospital was very personality dependent. I remember coming here for my surgery rotation in 1972 and 1973. I had long hair and beard, which was the style of the day. I met Dr. Claude Hitchcock for the first time, and he asked me: “Is your father Dr. Mike Belzer?” I said, “Yes, he is my father. “ “He is a fine man and a fine doctor,” Claude responded. “Now, am I going to have to tell him that you can’t work here until you cut your hair and shave your beard?” I stammered and said. “No sir, that won’t be necessary. I’ll take care of it.” I went home and thought about it for about a minute. And then I did what he wanted me to do; I cut my hair and shaved off the beard.
Back when I was a medical student, the hospital system revolved around the physician. The physician was definitely the “captain of the ship.” The schedule at the hospital was under his or her control. If the doctor wanted to go to a Twins game on Wednesday afternoon, it was easy to get the clinic cancelled. Or if the doctor only wanted to see patients with a certain illness on Thursday mornings, that could be arranged.
Now that has all changed. The physician is no longer the captain of the ship. Teams are very important. They deliver the care. And the teams can involve nurses, physician assistants, and pharmacists.
In 2011, a surgery professor at Harvard Medical School, Atul Gawande, wrote a very interesting article in the New Yorker magazine entitled “Cowboys and Pit Crews.” Cowboys refer to those people who are autonomous, who chart their own course of action for themselves. That is how I saw myself when I started practicing medicine. “Pit crews” refers to those teams of mechanics at the Indianapolis 500 races who work together very precisely and in a very coordinated way to make sure that the racecars are in top working order. Gawande maintains that health care is moving from the cowboy model to the pit crew model. That is certainly the case here at HCMC.
Iric Nathanson writes local history. He is the author of Minneapolis in the Twentieth Century: The Growth of and American City (MHS Press, 2010). Thomas R. Mattison worked at the General Hospital/Hennepin County Medical Center from 1966 to 1984 and was the HCMC Administrator for 7 years. They have co-authored articles about the history of HCMC for the Historical Society of Hennepin County and the Minnesota Historical Society.