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Healthcare in my Dad's Time

Of Barbers, Money Laundering, Cream Puffs and More

If I was more organized about my writing, you wouldn’t have this potpourri of topics bunched up into one post.  But, you opened this up, so here goes.  When I was small, my mother took brother Joe and me to get haircuts at a barber shop on Mission Street near Doctor Joe’s office.  An earlier Post mentions how my father bartered his services with various Mission District tradesmen and that included where we had our hair cut.  The Mission Street barbers did not warmly greet my mother when she walked in because most  barbers, at least those who got medical care from Doctor Joe, knew the “Raffetto Boys” all too well.  We were bad for business.  As long as we were in their shop customers turned around and left. 

Oh, we’d sit quietly at first, like little angels absorbed in reading all the comic books.  But, as soon as we got in the barber’s chair we began crying.  Crying isn’t the right word.  When the barber took up his scissors we howled at the top of our lungs and kept that up without stop until the haircut was finished.  People walking along Mission St. sometimes popped in thinking that someone was beating the tar out of us.  We made enough noise to make dogs cover their ears and cats to shriek as if in pain.

Doctor Joe was none too happy because two other barbers that had barter agreements to cut our hair cancelled the deal and became some of his best cash-paying patients.  My mother was well aware of our barber shop tantrums.  She’d just drop us off and scooted off as fast as she could to shop. I think that when we stopped screaming it was like when San Francisco’s  World War II air raid sirens stopped because in came our mother to pick us up. 

The haircuts (and shopping) were timed so Doctor Joe could take us home with him where he’d have his lunch.  He took a two-hour lunch, but ate quickly so he could putter about in his back yard garden.  I remember one time when we got to Doctor Joe’s office as he was ushering his last patient from the office.  But, instead of closing the office and taking us all home right away he told us to stay in the waiting room until he was ready.  The wait was too long for my brother and I who were likely tired from all that howling in the barbershop.  We got cranky causing my mother to knock on the door to the inner office again.  “What is it?” my father barked.  “How long are you going to be?” Mom asked.  But, before he could answer I said, “Poppa, I’m thirsty; I need a drink of water?”  With that, Doctor Joe opened the door to let us in. 

Once inside we gazed open-mouthed, unable to t believe what I was seeing.  For a long time afterwards I wasn’t sure the sight was real and thought it was a dream.  We knew Doctor Joe had a healthy respect for germs.  He often cautioned us to watch where we put our hands on doors and toilet seats.  But what we were looking was way beyond the extent to which he went in avoiding germs.  I held my paper cupful of water in my hands as I looked up.  Above me fluttering on lines of string that crisscrossed the office were wet, steaming money -$1, $5, $10 and even a couple of $20 bills.  They were attached to the string with paper clips and had been removed from an old sterilizer the Doctor usually kept on a shelf in the storage room.  The sterilizer was still steaming more money.  The last batch of paper money on the strings was still steaming and fluttering because Doctor Joe had opened the windows and a cool, stiff breeze was blowing in and quickly dried the money. 

US currency is printed on paper with a high linen content and stood the sterilizing process very well.  Doctor Joe fished out the last batch of money using a long surgical forceps.  Wearing rubber gloves he attached a paper clip and hung the bills on an empty line.  The wind made the paper money flutter and dance literally shaking the greenbacks dry.  Down came the dried bills.  Doctor Joe sorted, banded and then placed the money in the inside pocket of his suit.  Then he ushered us out the side door of the office marked “Private” in gold letters and locked up the office.  A short walk later we went into the nearby Hibernia Bank and the laundered money was deposited.

There were times when patients came in for an office visit whereupon Doctor Joe would make a diagnosis and proscribe treatment.  However, it was not unusual to find the patient had no improvement on the follow-up visit.  Doctor Joe questioned the returning patient to see if the treatment and medication he prescribed was being followed.  Reluctantly, patients would confess that they lacked the money to buy their medicine.

That’s why Doctor Joe cultivated and maintained good relationships with pharmaceutical “detail” men who came to his office.  If a detail man wanted an appointment during office hours, he had to fill Doctor Joe’s laundry list of drug samples, which he then gave his poorer patients for treatment of their various ailments.  Only then would Doctor Joe hear the “pitch” and accept samples of the pharmaceutical companies “drug of the month.”     The promoted drug might sit in bags at various corners of Doctor Joe’s office.  Even then newer drugs were often more expensive without proving greater effectiveness.  But,he never threw drug samples away; sooner or later they would get dispensed. 

The quantity of drug samples grew year after year.  There was no expiration date on the label because no law required it.  But, when that law passed, Doctor Joe reorganized his drug samples by expiration date.  When that date came, he took the brown paper bags of expired drugs and disposed of them.  By the way there was no law regarding safe disposal of drugs in those days.

Doctor Joe was not above taking advantage of his status as a doctor.  He was an avid reader, but that did not always mean he formed sound conclusions on matters outside the field of medicine.  If you had an opinion or view that differed from Doctor Joe’s you would do well to think twice before confronting him with it.  He could be pretty intimidating.  There was one person with a similar bent to my father.  That was my mother-in-law, Kathleen.  She stubbornly held her opinions and voiced them just like Doctor Joe.  It’s probably explains why Doctor Joe was never particularly fond of Kathleen.  But, they were always respectful of one another and the two of them always got along.

I’ve mentioned Doctor Joe’s attitude on germs, but not how sometimes practicality overcame this aversion.  That practicality can be illustrated by an incident that established  a positive relationship Doctor Joe had with my mother-in-law at the first dinner where my parents met my future mother-in-law. The dinner had gone smoothly; conversation flowed and dessert was about to be served.  Wonderful homemade cream puffs were proudly carried into the dining room on a big platter.  The platter kept her from seeing the edge of the dining room’s oriental rug.  She tripped and most of the cream puffs went flying.  There was a shocked silence and then Doctor Joe leaned over and with his dessert fork speared a cream puff that had fallen near him.  He blew on it, pronounced it fit for consumption and bit in.  My mother-in-law had made her home spotless for this occasion, something Doctor Joe likely noted.  Though they were worlds apart philosophically, never a cross word was uttered between Doctor Joe and my mother-in-law.

Sometimes patients wouldn’t follow Doctor Joe’s orders on their treatment.  Alcoholics fell off the wagon, but some patients thought they knew better than their doctor.  This was a period where families often used folk remedies.  Doctor Joe didn’t care if a patient used folk remedies as long as they also followed the doctor’s instruction and took his prescribed medicine.  Surprisingly, that often happened within our own home because my mother’s mother and aunt would come by with this horrible green herbal concoction that we were forced to drink.  But, we also took the medicines our father prescribed and he never heard about the herbal remedies.  If only folk remedies were used or medicine not bought and taken follow-up visits would show no improvement.  “Did you take the medicine I prescribed?”  “Did you put the ointment on as I told you?”  “How often have you gargled?”  Sometimes, the patient said they hadn’t gotten around to it or they forgot or a family elder forced them to take their remedy.  Either way, the patient got the riot act and more than one patient was told not to come back for further treatment.  “It’s a waste of my time when the patient won’t follow my instructions,” he would say to us.

When Doctor Joe opened a patient’s medical record or chart, there in longhand with penmanship that only he could read, he would quote chapter and verse on what had been instructed.  Then with exasperation in his voice he would bark out his recriminations.  You should know when Doctor Joe barked and bellowed, even though the door to the inner office was closed, you could hear the message loud and clear.  A favorite opening line of his was, “Why don’t you just go to the window there and throw your money out onto Mission Street where it might do someone some good?  You come in here with a problem you want me to treat and pay me good money, for what?  Why?  Why waste my time?  Didn’t you see all those patients in the waiting room when you came in?”  Then he would bark his instructions with the parting comment, “If you can’t do that, then find another doctor because I can’t help you.”  We in the waiting room would hear the private door open and close loudly to let the patient out and then would hear footsteps echo on the marble floor of the hallway.  Patients in the waiting room would shuffle nervously, but it was an object lesson to one and all.

Before the age of medical specialization began, Doctor Joe relied on his ability to diagnose medical problems, a skill of which he was quite proud and which was often used in collaborative consults by other local doctors.  When a specialist’s skills were needed those that were vetted by Doctor Joe were used.  Today, patients readily go directly to specialists and the primary physician (as we would now call Doctor Joe) wouldn’t even raise an eyebrow. 

Following World War II primary physicians worked more closely with specialists.  Specialists relied on the primary care doctor’s medical records for one thing.  There weren’t the plethora of diagnostic tests as is the case today. Because they couldn’t read the patient records kept by Doctor Joe, long discussions took place between Doctor Joe and each specialist he sent patients to.  Specialist never sent the referred patient to another specialist without first getting Doctor Joe’s approval, fearful of being cut off from further referrals.

Without Doctor Joe’s input the specialist would have had to conduct a complete history and physical.  Today, because of malpractice concerns, no specialist would accept data from the primary care physician’s patient chart.  They automatically conduct their own history and physical and all diagnostic tests.  It’s one of the many ways medicine costs so much more today.  Before 1948-1950 if a patient was using the specialist as the primary physician, Doctor Joe would tell the patient to stay with that doctor.  For one thing during World War II and shortly thereafter there was an extreme shortage of doctors throughout the whole Bay Area because so many had been drafted into the military.

During World War II that same doctor shortage caused Kaiser to set up a new type plan, we would now call an HMO.  Kaiser had told all local doctors that their medical plan would last only until the end of the war.  But, at war’s end, Kaiser decided to market its plan to the general public thereby earning the enmity of all Bay Area doctors, especially Doctor Joe.  If a patient’s employer installed Kaiser to provide health benefits, forcing all employees to use Kaiser, even when they were willing to pay out-of-pocket for Doctor Joe’s services, he would turn them away..  That did not sit well with many wives and their children, but Doctor Joe remained adamant.

Doctor Joe’s patients learned not to present themselves for an examination without having showered or bathed.  They also needed to come in wearing clean clothes.  Offenders were sent home to clean up and change before Doctor Joe would examine them (that germ phobia thing again).

Doctor Joe could afford to act pretty arbitrary during and shortly after World War II because the number of patients was greater than the number of doctors still in private practice.  But, by the 1950’s the supply of doctors had returned to normal throughout the Bay Area.  More and more specialists set up practices in the area, so primary care doctors, like Doctor Joe, were scrambling for patients.  That forced Doctor Joe to “mellow out.”

By the time action in World War II switched to the Japan Theater, our military draft had  stripped many draft-age doctors from their practices in San Francisco.  Doctors drafted started asking Doctor Joe to take over their practices until they returned.  By war’s end he was caring for the patients of seven other doctors besides his own.  In 1944 the Army learned that Doctor Joe was one of very few that studied tropical diseases and though he was beyond draft age wanted to draft him.  Doctor Joe repeatedly asked the Army to release one of the military doctors to take over all eight practices he was treating.  But, in the time it took to get the matter through the military bureaucracy, the war ended.

The Raffetto Boys (now three with brother Allen’s birth) were impacted as World Wad II ground on.  When we got up to ready ourselves for school, Doctor Joe would be sound asleep having come home well after our bedtime.  He’d be sleeping when we were going off to school.  Several times a week he’d come out of surgery and just sleep in the doctor’s lounge at the hospital. Then he would clean up and go make house calls before going to his office.  It wasn’t unusual for us not see our father for two or three weeks at a time.  Still, when it was raining I remember our father dragging himself out of bed and driving us to school.  My mother never learned to drive.  During those brief drives to school he would catch up on what we were learning and doing.

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2 comments
  1. Rod Goosen

    I have observed that of all kinds of insurance, health insurance is the most questionable because of the struggle between the insurance coverage company’s need to remain making money and the customer’s need to have insurance. Insurance companies’ commissions on wellness plans have become low, hence some firms struggle to gain profits. Thanks for the ideas you reveal through this website.

    1. Al Raffetto

      Hey Rod:

      I appreciated your comments. I look at health insurance as a three-legged stool and no one segment is lily clean on the plight of today’s U.S. healthcare delivery system. Government regs favor health providers, ( including hospitals) and drug companies. ACA is a step forward, but its biggest flaw is the absence of cost controls.

      ELR

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