Have you heard of William Osler? Maybe you are familiar with Osler’s nodes – raised tender nodules on the pulps of fingertips or toes, an autoimmune vasculitis that is a sign suggestive of subacute bacterial endocarditis.
Osler was a Canadian physician (1849 – 1919) and one of the founding professors at Johns Hopkins Hospital (in Baltimore, USA) as the first Professor of Medicine and founder of the medical service there. He was the first doctor to bring medical students out of the lecture hall for bedside clinical training. He has been called the ‘Father of modern medicine.’ Perhaps he should also be known as the Father of modern medical education, in that he was the first to insist that students learn from seeing and talking to patients and was responsible for the establishment of the first ever residency training programme. This concept spread across the English-speaking world and remains in place today in most teaching hospitals as the fundamental model of ‘on the job learning’ for students and residents in all specialities. He liked to say, “He who studies medicine without books sails an uncharted sea, but he who studies medicine without patients does not go to sea at all.” His best-known saying was “Listen to your patient, he is telling you the diagnosis,” which emphasises the importance of taking a good history – a fundamental medical skill which remains as, if not more, important in our high-tech age as it was in his.
But there are other sayings of Osler’s which are less well known, recorded in his Aequanimitas, a series of addresses to medical students about to go into practice.1 “Hard though the conditions may be,” Osler writes, “approached in the right spirit—the spirit that has animated us from the days of Hippocrates—the practice of medicine affords scope for the exercise of the best faculties of the mind and heart.” And, “The motto of each of you as you undertake the examination and treatment of a case should be ‘put yourself in his place.’“ He followed this by listing three simple actions that could make all the difference: “The kindly word, the cheerful greeting, the sympathetic look.” He also said, “Be careful when you get into practice to cultivate equally well your hearts and your heads.”
Although written in an earlier and very different age, these sayings apply equally powerfully to us today. PRIME advocates development of the person (patient) centred approach to medical teaching that Osler introduced, and one of our central concerns is that health professionals should ‘cultivate equally well (our) hearts and (our) heads’. Yes, we need to know, teach and keep up to date with the scientific knowledge and skills that define our discipline, but we need also to ensure that our hearts are adequately resourced and spiritually nourished so that we can always give the kindly word, the cheerful greeting, the sympathetic look. Are you adequately cultivating your heart?
What a difference those simple things make to our patients and students. Try it!
- Osler W. Aequanimitas with other address to medical students, nurses and practitioners of medicine. 3rd ed. Blakiston Division 1999.
The idea for this article came from:
- Sokol DK. The ethical gift box: suggestions for improving the ethical conduct of doctors