Chapter 01: An Australian Education; Inspired by Patients and Service More than Disease

Chapter 01: An Australian Education; Inspired by Patients and Service More than Disease

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Description

Dr. Keating briefly sketches his family background and talks about the important his Catholic faith in his life and medical practice.

He traces his educational path and explains the Australian educational and scholarship system.

Dr. Keating talks about deciding to become a physician when he was in high school, recalling instances when he observed physicians at work and sorting out family dynamics and complex problems.

He next talks about his medical education in Australia. He explains the system of clinical education in Australia and how this fostered a sense of altruism among physicians which was eroded through changes to the system in the 1970s.

Identifier

KeatingM_01_20140513_C01

Publication Date

5-13-2014

City

Houston, Texas

Topics Covered

The Interview Subject's Story - Educational Path; Personal Background; Inspirations to Practice Science/Medicine; Influences from People and Life Experiences; Character, Values, Beliefs, Talents; MD Anderson History

Transcript

Tacey Ann Rosolowski, PhD:

I’m Tacey Ann Rosolowski, and it is the 13th of May 2014, and today I am interviewing Dr. Michael Keating for the Making Cancer History Voices Oral History Project run by the Historical Resources Center at the Research Medical Library at MD Anderson Cancer Center in Houston, Texas. Dr. Keating came to MD Anderson as a faculty associate in 1975 in the Department of Developmental Therapeutics. He became an assistant professor in 1978, and today he is professor of medicine in the Department of Leukemia in the Division of Cancer Medicine. This interview is being conducted in a conference room in the Department of Leukemia in the Faculty Center on the main campus of MD Anderson. This is the first of two planned interview sessions, and the time is 2:25. So thank you again for devoting your time to this project.

Michael Keating, MD:

It’s a pleasure.

Tacey Ann Rosolowski, PhD:

Well, we decided ahead of time that we would start just at the beginning. So if you could tell me where were you born and when, where did you grow up.

Michael Keating, MD:

I was born in Melbourne, in Australia and—

Tacey Ann Rosolowski, PhD:

And the date?

Michael Keating, MD:

July the 1st, 1943. And I was one of four children and I was the only boy, and had a typical Australian life with a lot of sporting activities. I went to elementary school with nuns and went to high school with the Christian Brothers, and I think that that was part of what put the sense of right and wrong and responsibility and how you should conduct yourself, because they were tough teachers in some ways. They expected you to do your work, and if they didn’t, they would contact the parents and they would tell the parents what was going on and what was not going on.

Tacey Ann Rosolowski, PhD:

Now, were you, yourself, raised Catholic, or did you just attend Catholic school?

Michael Keating, MD:

No, I was raised Catholic and still practice my religion because I’ve never found anything that’s been better, and I find that if I don’t stick to those principles, I’m not happy with myself, so it’s been an important element of my life. My parents were upper-level poor, so that my father worked as a clerk in the post office for his whole life. My mother was a hat maker. And my mother decided that she would marry my father on the condition that there was never to be any alcohol in our family because her family had a number of alcoholics, including her brothers. And my father agreed to that and stuck to it right through their marriage, never drank from the day they got married until the day that my mother died.

Tacey Ann Rosolowski, PhD:

So you had a lot of instances around you of principles.

Michael Keating, MD:

Yes.

Tacey Ann Rosolowski, PhD:

Interesting.

Michael Keating, MD:

And my mother was probably the stronger member because she had to make sure that things were run well in the house. My father was more jolly type. He was very sociable because we weren’t in society in any way. Through my entire education career, everything occurred by scholarship, and one of the great things and a great debt that I owe to Australia is that when I told my father I was going to go to medical school, he said, “You can’t possibly do that, because that’s only for rich people.” And that was the concept everyone had, but if you got the scholarship, they paid your entire freight through medical school, and medical school in Australia starts straight out of high school, so you don’t do a baccalaureate and then go on to med school. So I was in medical school when I was seventeen.

Tacey Ann Rosolowski, PhD:

Now, I noticed that your degree is an MBBS, and so that—

Michael Keating, MD:

It’s the European equivalent of the MD. It’s a bachelor of medicine, bachelor of surgery, and you see the same thing in almost all the commonwealth countries, Canada, England, Scotland, South Africa, all the places that used to be pink on the map because they were part of the British Empire. So that you go straight through and do three years, pretty much, of basic science, physiology, biochemistry, etc., and the last three years you’re doing sort of clinical rotations at the same time that you’re learning the principles of pathology and etc.

Tacey Ann Rosolowski, PhD:

Now, when did you first decide that you were going to be a physician?

Michael Keating, MD:

I decided when I passed my senior exams. The exams in Australia at that time were much of what it was like in the United States, but there were no modules that you went through in medical school, so that at the end of medical school you went straight through, and all the subjects in their totality, in medicine, surgery, gynecology, etc., were done over about a one-week period with multiple evaluations. The same thing happened in high school, that everyone did the same exam, the same written exams in, you know, math and science and English, etc., in a big exhibition hall. So all of the final year, or senior year of high school, all congregated at the Exhibition Building and did all their exams at the same time.

Tacey Ann Rosolowski, PhD:

So how many people in one room?

Michael Keating, MD:

Oh, thousands. And it was a massive building, so that it was just—I had no idea whether I was going to do well or not do well, etc. And then when I found out that I’d passed everything and was going to be eligible for a scholarship, I was talking with my friends, and a few of them were going to law school and some were doing engineering. And the thing that impressed me most was that I thought that I would never be bored doing medicine, and the only contact that I’d had with medicine at all had been the primary-care physician in our local area. It was a family affair that there was a Dr. Curry [phonetic] initially, and then Dr. Curry’s son took over. There was just the waiting room, and I’d look around the waiting room and there were all these interesting things happen with family dynamics and mothers with sick children, etc., and they were all somehow being sorted out by this primary-care doctor. So I thought, “That’s interesting.” Some of my friends that I used to play sport with had decided that they were going to do medicine, so that there were enough support people that I thought I could go along with. I think that there are only three out of the six that went along that actually made it through medical school. The others went off to dental school and etc. One became an Olympian in high school or high jumping. It was just a nice group of guys, because there were very few women that went into medicine at that time. When I went to high school, it was an all-boys high school, and we had sister institutions, the high school for girls and etc. I think twice a year we’d have some sort of social contact. That was always very awkward because we hadn’t had any practice at hanging around with girls.

Tacey Ann Rosolowski, PhD:

The mystery of girls. (laughs)

Michael Keating, MD:

That’s right, which now continues well into my senior years. They’re still mysterious, but they’re still wonderful in their mystery.

Tacey Ann Rosolowski, PhD:

Well, that’s good. Keeps you feeling alive. (laughs)

Michael Keating, MD:

Yeah.

Tacey Ann Rosolowski, PhD:

So tell me about going to the University of Melbourne for your medical program. And I noticed, too, in your CV, you actually have two degrees listed, one from St. Vincent’s Hospital Clinical School and then one from the University of Melbourne. So I assume that’s part of the system at work in Australia.

Michael Keating, MD:

Yeah. The University of Melbourne is the senior medical school, and the next one that came along was Monash University, which I think only started in 1960, so that it was just getting under way.

Tacey Ann Rosolowski, PhD:

And that’s Monash?

Michael Keating, MD:

Monash, M-o-n-a-s-h. There is a river that runs through Melbourne and so that the medical schools that were there are associated with different hospitals. The rural Melbourne hospital was one of the ones with the University of Melbourne, and St. Vincent’s Hospital was the other one that was associated, and subsequently there have been more of them that have been associated along the way. And with Monash University, it was the Alfred Hospital and Prince Henry, so that that was the first time that they started to double the number of medical students. So they had very little interaction, and even their examinations, they had the same written examinations that we had, but the clinical parts of things were separate.

Tacey Ann Rosolowski, PhD:

Okay. So tell me about your medical education, its impact on you.

Michael Keating, MD:

I now realize that I was a really bad student, that I didn’t know how to study. I think I got through high school on perhaps just raw intellect, and subsequently, I’m sure I have ADHD. And my daughter, who works at MD Anderson, Dr. Anna Franklin, she works in our pediatric department and runs the adolescent and young adult program, so she was discussing with someone and said, “Yes, my dad’s certainly got the worst ADHD in the family.” I used to be fascinated in listening to lectures, but didn’t take notes of any significance, I had all these scribbles, so was always just sort of scratching around to pass the exams. And it wasn’t until the final year of medical school, really, that I got my stuff together, and it was just on the basis that it dawned on me that if I did carry through and marry when I finished medical school, that I would actually have to support a wife, so that I probably got a bit more serious. But I think it was more an interest. I think the strongest feature of my career has been that the patients have always interested me more than the diseases that they have, so that in the final year when you’re doing a lot more direct patient contact, that became more interesting to me, and I’d find out, well, this particular patient has a problem, and I’d go and read about that problem. But just going through the chapters, etc., one after another, was not something that I was very good at.

Tacey Ann Rosolowski, PhD:

Well, it’s interesting that you talked about when you were observing the primary-care physician when you were younger, the first thing you mentioned was family dynamics. So those social and personal aspects of being a patient were really key for you.

Michael Keating, MD:

Yeah, and I think that I probably in that process got to sense that Dr. Curry was a very impressive man. He didn’t have personal charisma, but he had great—you always had the sense that he was very respected. They had a very different system of education, clinical education, in Australia, in that almost all of the teachers, apart from the Department of Medicine, the Department of Surgery, etc., and the Department of Pathology, for example, they were all honorary, that it was considered to be a sign that you were special if you got an appointment as an honorary surgeon or an honorary physician, so that there would be six inpatient honorary physicians that would go around and teach, and there were six honorary surgeons that would teach, and then there were some specialty groups, but they got no salary. But the good thing for them was that they were introduced in to their referring physicians after that so that their students ended up being the people that would refer to them, so that you got a sense that altruism was an important element, that it was an important characteristic of being a doctor, that you did something for mankind that you weren’t getting paid for. And I think that the whole of healthcare in Australia suffered when they decided that while perhaps some of these guys didn’t do as well as they should, so now we pay them for everything that they did, and then we could challenge them if they didn’t measure up. But from that point on, everything was about how much you could charge for different things, and it just changed the whole dynamics. And this was the point, I think, in probably the early seventies when I became more and more aware that it wasn’t just going around and looking after patients, but there was a business of medicine, that practices were income-generating for the doctor and etc. Because the hospital that I worked at, St. Vincent’s, was run by the Sisters of Charity, and their motto was, “The work of charity drives us on.” And our job was to look after the needy poor, so that there were these big wards with twenty people, with little curtains around them, etc., in old buildings, and that was my experience of what medicine was supposed to be like.

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Chapter 01: An Australian Education; Inspired by Patients and Service More than Disease

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