The Inspirational Teacher
An excellent read on the life of Sir William Osler can be found in Charles S Bryan’s Osler: Inspirations from a Great Physician.1 Here are some important take-home messages:
Time Management
Osler urged setting definite goals while methodically planning each day. Through the concept of “day-tight compartments,” Osler said to worry less about the past or the future, but instead focus on the present. His method was to set aside specific hours of each day for writing, while being sure that he also had time for his interpersonal relationships. Osler believed that “punctuality is the prime essential of a physician—if invariably on time he will succeed even in the face of professional mediocrity.”1
Find a Calling
Before deciding to pursue medicine, Osler enrolled at Trinity College in Toronto with a plan to enter the ministry. Even after he was well established in medicine, he was urged to consider other career paths (eg, university presidency and politics), but he always declined. In perhaps his greatest speech to a medical student body, titled “Aequanimatus,” he spoke of having found his calling.
“To prevent disease, to relieve suffering, and to heal the sick—this is our work. The profession in truth is a sort of guild or brotherhood, any member of which can take up his calling in any part of the world and find brethren whose language and methods and whose aims and ways are identical with his own.”2
Find Mentors
Osler sought out many mentors in his life and in tribute, dedicated his most celebrated book, The Principles and Practice of Medicine, to three of them. He also admired and was a serious student of many great writers; some of these authors are suggested bedside reading for all medical students for a liberal education. In addition to their studies, students of his time were urged to read for half an hour each day from a suggested bedside library that included the Old and New Testament, Shakespeare, Montaigne, Plutarch’s Lives, Marcus Aurelius, Epictetus Religio Medici, Don Quixote, Emerson, and Oliver Wendell Holmes’ Breakfast-Table Series.
In addition, Osler’s historical mentors included Thomas Linacre (1450-1524), William Harvey (1578-1657), and Thomas Sydenham (1624-1689). He often sought opportunities to surround himself with medical students. They were frequently invited to partake in beer, biscuits, and cheese at his home in Baltimore.
As Dr Harvey Cushing noted, “In these surroundings, he was at his best.”3 Students particularly in his favor would be invited over one hour earlier than the rest. Special students were also given latchkeys to his library so they could come and go as they pleased and peruse his vast collection of books. Osler looked to students to stimulate him and serve as an anecdote against premature senility. These relationships were mutually beneficial.
Be Positive
Osler was, by all accounts, an optimist. His historical mentors Earl Nightingale, Norman Vincent Peale, and Sir Thomas Browne were all with similarly positive attitudes. In “Aequanimatus,” Osler urged medical students to choose their path and decide what type of doctor they were to be. He believed that we could create our own future and decide what type of life we may live. “To each one of you the practice of medicine will be very much as you make it—to one a worry, a care, a perpetual annoyance; to another, a daily joy and a life of as much happiness and usefulness as can well fall to the lot of man.”
Bryan notes that “most positive people give generously, and Osler was no exception.” Throughout his life he gave others what he had—be it a coat to a man shivering in the cold, tutelage to a student, or care for a patient. There are many stories of how he befriended and was of help to others.
Bryan recounts one story that is especially poignant: Osler, on his way to an Oxford graduation and dressed in academic gown, was asked to see a small boy with severe whooping cough complicated by bronchitis. The child would not eat. The nurses and his parents tried to feed him without success. Osler did not have much time but acted as though he had plenty. He examined the child briefly, and then sat down at the bedside. He carefully peeled a peach, coated it with sugar, cut it into small pieces, and offered them to the child one at a time, telling the boy that it was special fruit. Hurrying off to the ceremony, he gave the boy’s father a bleak prognosis but continued to visit the child daily for the next 40 days. Because the boy had seen him as a magical figure in his academic regalia, Osler brought his robe and put it on outside the room before each visit. The child began to improve a few days after the first visit and made a full recovery.
Learn and Teach
Lifelong learning was as important to Osler as was teaching. Osler, like Hippocrates, strongly advocated the necessity to constantly sharpen your skill of observation, an essential component to becoming a physician. Students were taught to use all of their senses. A quote often attributed to Osler is, “Listen to the patient, he is telling you the diagnosis.”
Care Carefully
Osler is described as someone who demonstrated care by his actions and not words. Bryan importantly notes, “The physician’s first duty is to be competent at what he or she professes to be able to do, and to do it consistently and well. In a sense, acts of benevolent competence are compassion, while compassion without competence is fraud.”
At some point, you will likely meet clinicians in your specialty who on the one hand are kind, polite, warm, and caring—yet their actions or clinical judgment may be grossly wrong. Likewise, you will come across others who practice state-of-the-art care with evidence-based and logical recommendations, but have poor interactions with the patient that ultimately sabotages the relationship.
A true healer in the Osler tradition would do neither. Clearly being dedicated to lifelong learning, being observant, developing methods, and being thorough is a good start for every healer. In addition, healers must be mindful that they are taking care of a person and not a disease. One of Osler’s practical recommendations was, “Never leave the bedside without a word of encouragement.”
I conclude my condensed review of Osler by highlighting his success as a role model, an embodiment of the humanistic physician. Osler understood that the patient plays a central role in the physician’s work. Osler wrote, “The good physician treats the disease; the great physician treats the patient who has the disease.” Therefore, it is much more important to know what sort of patient has a disease than what sort of disease a patient has.
Osler is often called the father of psychosomatic medicine because of his astuteness in recognizing this key concept: When it comes to helping our patients with their illnesses, one cannot separate the somatic from the psychological, the physical from the emotional, or the patient from his or her unique cultural background and life experiences. ■
References
1.Bryan CS. Osler: Inspirations from a Great Physician. Oxford University Press, 1977.
2.“Teacher and Student.” Valedictory address to the University of Minnesota, 1892. In Aequanimatus. 3rd ed. New York: McGraw-Hill, Inc., 1939;23-41.
3.Cushing H. The Life of Sir William Osler. Oxford: Clarendon Press, 1925.
4.Colgan R. Advice to the Healer: On the Art of Caring. 2nd ed. New York: Springer, 2012.
Richard Colgan, MD is the vice chair of medical student education and clinical operations, as well as a professor at the University of Maryland School of Medicine, Department of Family and Community Medicine.
This column is adapted from “Advice to the Healer: On the Art of Caring,” by Dr Colgan.4 For more information, visit www.advicetotheyoungphysician.com.