ON READING HARRISON'S PRINCIPLES OF INTERNAL MEDICINE FOR THE LAST TIME

CHAPTER 1

My medical career started in 1973 and wow its now 2024.. I recall reading Harrison's for the first time over forty years ago and had to use Dorland's medical dictionary every few words. Words like leukocytosis, uremia, salpingo oophorectomy, made me laugh at my ignorance. Eventually I learned their meaning and continue to relate and deal with their significance.

So now I start on page one, "The Enduring Values of the Physician."

"That Sympathy and understanding are expected of the physician"

I've always tried to live up to that expectation. I recall the old baseball manager Sparky Anderson's admonition that being nice doesn't cost a dime." I never forgot the 1984 Detroit Tigers or Sparky Anderson's advice.

Early in my career I read of doctors who did things that violated Sparky's advice. Some billed dead patients for profit. A local doctor gave chemotherapy to patients that did not have cancer. And then there was the doctor who molested the female gymnasts and shook the profession.

But I still believe in and want to emulate the ideals of doctors like Arrowsmith and the brave doctor Rieux in Camus' "The Plague," Albert Schweitzer, and Dr. Best who discovered insulin and saved many lives and sold the patent for one dollar. (Imagine big-pharma doing that today)

Recall Francis Peabody's "The Care of the Patient," a lecture delivered while he was dying of cancer. It wasn't about him, it was about the patient. "The care of the patient is in caring for the patient."

."The good physician knows his patients through and through, and his knowledge is bought dearly. Time, sympathy and understanding must be lavishly dispensed, but the reward is to be found in that personal bond which forms the greatest satisfaction of the practice of medicine. One of the essential qualities of the clinician is interest in humanity, for the secret of the care of the patient is in caring for the patient." Francis Peabody  1926

I came across the following in researching Sir William Osler. 

"Medicine has certainly grown both powerful and successful. Yet it is also confronting hurdles that would have been unimaginable in Osler's time. Physicians are now the professionals with the highest suicide rate, a burnout rate as high as 70%,, rampant depression, dwindling empathy, a predominantly negative perception by the public,, and a disturbing propensity to quit. These, of course, may just be symptoms of an increasingly meaningless environment wherein doctors have become small cogs in a medical-industrial complex they can't control or even understand. "

I can't imagine Sir William Osler having to beg a clerk for a prior authorization to get his patient a needed medication.

The following is an account of a clinical encounter by Sir William Osler:

The first case concerns a young Englishman visiting Montreal on business. Osler met him at the Metropolitan Club in Montreal, where Osler, being a bachelor, frequently took his meals. One day the young Englishman didn't look very well, and Osler asked him what was wrong, attended to him, and diagnosed smallpox. It became obvious that his case was going to be severe,and Osler arranged for him to be seen by the leading internist in Montreal, his mentor, Palmer Howard. Osler got him into the hospital, but the young man went downhill and died. Thereafter, Osler wrote a factual and detailed letter to the young man's parents. Osler described exactly what had happened and what had been done, stated that the young man had gotten the best care, and explained that during his last hours he had frequently spoken of home, had asked Osler to read him a passage from Isaiah that was his mother's favorite, had talked about his mother, and had died peacefully. Osler did not hear anything further for about 30 years. Then at Oxford at a reception, a woman came up and said, "Would you happen to be the same Dr. Osler who took care of my brother?" And he said, "Yes, I remember." The woman said, "I can't tell you what your letter meant to my mother. She cherished that letter for the rest of her life."