Mentors Matter October 23, 2023
Sir William Osler MD - The Father of American Medicine
Sir William Osler MD (1849 - 1919) is the most pre-eminent physician of the 2oth century. He is the ideal of the American medical doctor. A century of critical appraisal has not tarnished his image or altered this preeminence. Though he bears the well-worn title of “Father of American Medicine”, he was by birth a Canadian and can rightly be claimed by Canada, the United States, and the United Kingdom as revolutionizing modern medical practice. He was part of “the big four” (Osler, Welch, Kelly, Halsted) at the newly developed John’s Hopkins medical school that took the professionalization of American medical education from a con-ceptual and theoretical revolution spelled out by Abraham Flexner in 1910 to a systema-tized bedside clinical practice with an ethical professional character built upon beneficence.
William Osler was the complete physician with impeccable clinical skills, professional bed-side manner with compassion for the individual, an unparalleled educator who revolution-ized medicine with bedside teaching, a renown and polished speaker for the medical pro-fession, a humorous and even mischievous colleague who was always playing pranks, a prolific reader with a grand library (to which he “awarded” favorite junior medical staff a key to the library they could use at any time), and an equally prolific writer assembling over 1,600 “works” to include essays and books such as his opus, “The Principles and Prac-tice of Medicine” (1891). His name is all over the medical lexicon with Osler nodes (bacte-rial endocarditis), Osler-Weber-Rendu (hereditary telangectasia), Osler disease (polycythe-mia vera), Osler-Libman-Sack (SLE), and others.
But with all of William Osler’s accolades including his knighting as “Sir” by the English par-liament, the genius of William Osler was that he was not one! He was by all accounts, a very average student from humble ordinary beginnings. He was even expelled from school at the age of 14 (for pulling pranks). He was the child of a Christian missionary couple who planned to go into religious ministry but switched to medicine. In medical school, he planned for ophthalmology but it was so highly competitive, he felt he would have little chance given his early mediocre academic acumen so switched to a “generalist” (internal medicine), and found himself teaching at a new medical school at John’s Hopkins after initially refusing the offer. “The big four” were all young medical colleagues in their 40’s and viewed as not a great deal older than the students. From these fairly average and humble moorings, all of modern American medicine and even global medical professionalism have been founda-tional built. His emphasis on what we would call today “participatory knowledge” and “clini-cal mentoring”, and view as a “new way” to involve the student as an “active learner” were novel instructional methods implemented by Dr. William Osler in the late 1800s and early 1900s!
If William Osler was no polymath, no genius, no fortune of powerful inheritance, what was his secret to becoming the paragon of a professional physician? His secret was Work (inten-tionally capitalized) built upon a system driven by evenness of character and charity. Work for Dr. Osler was not characterized by a “work-a-holic-ism”. Work for Sir William Osler was an honorary, if not divine calling to serve humanity. This kind of Work defined not an occupa-tional trade, but an entire way of living, in which a mediocre student of ordinary means could be trained through good habit to be an exceptional healer with skill, compassion, and knowledge. This was not magic or special gift or inheritance, this was the hard Work of medical education, available to those willing to submit themselves to the difficulties of such an honor. His inspiration was his philosophy of medicine which was inseparable from his philosophy of life. His aphorisms about how to study and how to behave as a medical pro-fessional and how to behave in life— we could say his non-scientific teachings— were the summit of his monumental influence in American medicine, of which sadly many contem-porary medical students and physicians may be unaware.
To only speak about Sir William Osler MD, runs the risk of reading a boring historical story told by lamenting older physicians about “the way things were.” To want to emulate Osler today, one must fall in love with the person of his ideas and ideals. To fall in love with Dr. Osler, it is best to listen to him. Here are just a tiny fraction of his aphorisms, as applicable after 2020 as they were after 1910:
On Studying in Medical School
“Let me add a word of advice on the method of studying. The secret of successful working lies in the systematic arrangement of what you have to do, and in the methodical performance of it….Make out, each one for himself, a time-table, with the hours of lecture, study, and recreation, and follow closely and conscientiously the program there indicated. I know of no better way to accomplish a large amount of work, and it saves the mental worry and anxiety which will surely haunt you if your tasks are done in an irregular and desultory way.
On Applying the Discipline of Routines to Medical Practice and Life
“Ask any leader in a profession the secret which enables him to accomplish much work, and he will reply in one word system, or as I shall term it, the Virtue of Method…a system so ingrained that it becomes an integral part of his being….“Take away with you a profound conviction of the value of system in your work.”…“To follow the rou-tine of classes is easy enough but to take routine into every part of your daily life is a hard task.”“…believe the truth that fair average abilities, well-used, often carry their owner above the heads of abler men…”
On Exercising Empathy with Patients through Self-Humility
“The more carefully you scan your own frailties, the more tender you are for those of your fellow creatures.”
On Medicine Not as a Business but as an Honor to Serve Humanity
“You are in this profession as a calling, not as a business… once you get down to a purely business level, your in-fluence is gone, and the true light of your life is dimmed.”…“The practice of medicine is a calling in which your heart will be exercised equally with your head.”
Wellness or Healthy Preservation
“The atmosphere is darkened by the murmurings and whimpering of men and women over non-essen-tials….Things cannot always go your way. Learn to accept in silence the minor aggravations.”…“Live neither in the past nor in the future, but let each day’s work absorb your entire energies…” “…set earnestly at the little task at your elbow, letting that be sufficient for the day.”…your happiness depends upon the attitude of the mind which you habitually assume towards your fellow creatures….“I give you a single word as my parting command-ment…charity.”
REFERENCES
* All quotes from Silverman, M; Murray, T.J. and Bryan, C “The Quotable Osler” (2003)