When Your Doctor is Your Friend ("Insights from Dr. Sanstead and 35 Years of Practice in York")

Jack Sanstead, M.D.

We have an absolute need to live with other people.  As Rabbi Jonathan Sacks has noted, “We reproduce as individuals, but we survive as members of a group.“  This is how we are still here.  Dr. John Sanstead recently retired from his practice of medicine  and he frequently reminded me that we are “big social animals.”

When the brain is finished with the task at hand it lapses into a default network.  That is, what it does when it has nothing pressing.  Matthew Lieberman (in “Social: Why Our Brains Are Wired to Connect”) has studied this and concludes that the "default network" is there to help us do our most important job as humans, to learn how to cooperate and share with others.  Thousands of hours of brain activity go into making sense of the people around us and of our role in the group.

There may be a limit to the size of such groups. According to the anthropologist Robin Dunbar this relates to brain size.  Our large brain allows us to have stable relationships with 150 people, casual friends.   These are “relationships in which an individual knows who each person is and how each person relates to every other person.”  Fifty is the number of our close friends.  Fifteen is the number of people we confide in and sympathize with, but are not true intimates.  Five is our closest support group, our best friends or family members.  On the other end of the scale, we may be able to put a name to a face for 1,500 people.  The composition of groups changes through time.

The number of our closest supports

When I was 23 a member of my close group, my family doctor and neighbor, died two weeks after he diagnosed his own pancreatic cancer.  At his funeral those that gave eulogies felt deeply that they were his friends.  So did the other shocked mourners in the audience.  We all felt the same connection.

More than 40 years later my general internist who cared for and counseled me though several difficult problems retired, and I again had a sense of loss.  Though he could no longer address my health he did agree to an interview.  I wanted to know what he had seen in more than 35 years of practice in York and what his concerns were for the future.  We sat in his cozy living room with the soothing “tick-tock” of a grandfather clock to keep us company.

I put my iphone on the coffee table between us and tried to turn on the recording app but the little “working” thing went round and round so I resorted to pen and paper. 

Why did he decide to become a doctor?  At Dartmouth he majored in Chemistry and minored in Religion.   He considered basic research, but he realized he preferred the socialness of listening to people, that this is where he would fit in.  In the late 1960’s youthful idealism and the reality of  a deeply unpopular war permeated college campuses and shaped his view of a world that was not black and white.

Vietnam War protest at Harvard in the 1960s

How would he contribute?  He turned to medicine.  He got his degree from Jefferson Medical College and did Residency training at Duke and the University of Pennsylvania.  He settled in York for his practice of medicine and geriatrics.   He had mastered science and learned textbook medicine in training but had brought the ability to feel what others feel with him.

Dr. Sanstead joined a practice and taught residents.  He greatly enjoyed being needed and found that he could know his patients through active listening.  After establishing a diagnosis guiding the patient  through (sometimes difficult) treatment or (imperfect) management  was rewarding.  But he always remained careful when recommending action. He took time to know the patient and their family dynamics; time to befriend them.  He accepted them just as they were, hoping this would allow them to accept themselves.  He always saw the good.  And as a friend, he needed to protect. 

Among the problems confronting those with illness, problems that may be physical, emotional, psychological, or  financial, one that particularly worried Dr. Sanstead was the overuse of prescription medicines.  While medicines for hypertension, for example, have been spectacularly effective in preventing heart failure, kidney failure, and strokes, others he saw as of dubious benefit and of unproven long-term safety.

For this he directed me to “An American Sickness” by Elisabeth Rosenthal who notes that in “1991 the FDA relaxed its rules for what constituted proof that a drug was effective…(as) drug makers no longer had to show that their product actually cured the (illness)...they could measure things like blood markers” (p.99-100).  He saw that this warped the pharmaceutical industry, as “pushing” of drugs for profit became the sole driving force, not the welfare of the patient . The cost  of medicines soared, and the benefits were inobvious.  This made him feel sad.  He protected his patients by refusing to be swayed by the lure of using the latest (and heavily advertised)  drugs without convincing data to support their use.  (Direct-to-consumer advertising is permitted only here,  in New Zealand, and in Hong Kong.)  He was also exceedingly cautious not to order  testing or recommend surgery when the benefit was questionable or marginal.

Dr. Sanstead loved seeing his patients out in the community, and feeling a part of it.  He  loved learning from patients and watching them grow, and said that he would have seen them for free (well, maybe not entirely for free).

Since leaving practice he has felt somewhat lost, he sorely misses the socialness of his life’s work.  His own Dunbar number used to be in the tens of thousands, now it is a whole lot lower.

Published in the York daily Record 11/12/17.