Page 12 - Boca Club News - August '23

Page 12, Boca Club News

The occasion of this, the 200th issue of Boca Club News as we look back at our first 16 years of publishing experience,
seems an appropriate time for Dr. Nagler to honor the man who long ago influenced his own life and career. – NAS, Editor

Medical Matters: Remembering Sir William Osler

By Richard Nagler, M.D., a member and influenced students and practitioners for more than understand that the best a doctor can do is relieve
of Broken Sound Club and retired 50 years. After J. D. Rockefeller read it, and as a direct symptoms and make a patient more comfortable. Never
physician. After graduating from corollary of the book, he established the world-famous tell a patient he is beyond all hope. Nature will do this
the University of Pennsylvania Rockefeller Institute of Medical Research. In 1905 Osler quietly and in good time. Understand that when patients
and New York University’s School became the Regis Professor of Medicine at Oxford, and become aware they have a fatal disease they invariably
of Medicine, Dr. Nagler served in 1911 he was knighted. It was there that he capped his go through periods of disbelief, anger, false optimism and
his internship and residency at illustrious career. despondency as their condition relentlessly deteriorates.
Baltimore City Hospital and Johns This is how he described what being a doctor is all If a doctor has not been truthful the patient will lose
Hopkins. He followed that with a about: “He is not raised to command his fellow man, nor confidence, which will seriously compromise the role
Fellowship in Gastroenterology at Yale University School is his name immortalized in history and sung like those of the doctor in guiding the patient and the family. It is
of Medicine, and was then Chief of Gastroenterology who wear the uniform and risk their lives for their country. better for the doctor to convince the patient that there is
at Fitzimmons General Army Hospital in Denver. He He does not sit among the judges of the land. The high much to be done to treat the illness, but to expect difficult
returned to the Yale Medical School for one year as an places of brilliant statesmanship are not for him. The world days ahead. As the situation invariably deteriorates the
Assistant Professor of Medicine before opening his own can reward him with little beyond a successful practice. patient will welcome the continued presence of the trusted
successful private practice in Internal Medicine and But while soldier and statesmen win honor and fame, the physician who will do everything possible to relieve pain
Gastroenterology. During that time, he also served for physician will draw to himself the love and gratitude of and suffering.
ten years as Chief of Medicine at Huntington Hospital in manifold hearts. Medicine is a noble heritage made so by He counseled his students that the fight they have to
Huntington, N.Y. the generations of men who have unselfishly sought to do wage is against ignorance, quackery and fallacies among
I am devoting this month’s Medical Matters column the best they can that they could for suffering mankind.” the masses. He stressed that it is diagnosis, not drugging,
to make my readers aware of my own personal hero, Sir When I graduated from medical school in 1956, I that is their chief weapon, and no two cases are alike
William Osler, who inspired me not only to become a believed that I had just entered the noblest profession in in all respects, but the patients themselves who have
doctor, but to follow the example he set as to what it takes which I would find a great challenge and unique opportunity peculiarities which modify the action of disease.
to be an effective one. to do something important and useful with my life. Like There is a great weakness in the guidelines for
We are currently nearing the end of a once-in-a-lifetime so many graduates then and even now, there remains that physicians to follow that have been established by
pandemic that has adversely affected most of the world’s initial idealistic glow in the tradition of Osler of what being organized medicine, HMOs, insurance companies and
population. It has severely tested the effectiveness of a doctor really means. However, that is being diminished the government for a sort of “cookbook medicine” that
the health care system in our country. We are fortunate today by the harsh realities of medical malpractice litigation, interferes with a much better individualized approach to
to be the beneficiaries of the monumental technological managed care, interference of insurance companies and the each patient. Osler said that the blind faith many of the
advances that have transpired especially over the last 50 government, causing disillusionment and a negative effect population has in medicines illustrates the capacity of self
years, resulting in disease prevention (vaccines), faster and on the doctor-patient relationship. deception. What better example of that is the belief the
more accurate diagnosis, and both medical and surgical In sharp contrast to existing medical dogma, Osler public has in the miracle cure derived from antibiotics
treatments for a wide variety of medical conditions. advocated bedside training. He taught that “medical care given for viral infections for which they have no value, but
However, at the same time we have witnessed a decline of begins with the patient, continues with patient and ends when their condition naturally improves they mistakenly
hands-on medicine and an erosion of the coveted doctor- with the patient. Books and lectures play a lesser role. The attribute it to the antibiotic.
patient relationship. education upon which the young doctor is engaged is not Even more important is that this practice encourages the
Sir William Osler (1849-1919) is considered by many a medical course, but preparation for a lifelong education emergence of dangerous resistant strains of bacteria. Osler
to be the father of clinical medicine. He is a hero to me process.” said that “one must be skeptical toward the pharmacopeia
and an inspiration, not only for his vast medical knowledge Osler counseled that the personal character of a as a whole, and do not put strange medicines or every new
but for his humanity. physician is critical in gaining the confidence of a patient product into patients who are subjected to TV ads to use
Although he did contribute to research, he was not a that allows him to be an effective healer. He urged that new products often no better than ones older, tried and
great scientist. He was an educator without peers who the doctor care more for the individual patient than for proven to be effective and far less expensive. Osler told
revolutionized clinical medical teachings, and he was the some special feature of the disease. “One must love his his students, “There isn’t a drug for every malady. If many
ultimate diagnostician whose bedside skills are legendary. fellow man to serve the art of medicine.” He maintained different drugs are used for a disease, all are insufficient.
He believed that “one who stood aside from the process that the most dangerous foes doctors must face are apathy, The doctor should attempt to educate the masses not to take
of humanizing and being humanized by close personal indifference, carelessness and a contempt bred of self- medicine as a panacea. The obligation of the doctor is to
contact might be a scientist, but never a doctor.” satisfaction. conduct treatment to restore the patient to health quickly
Interestingly, as an undergraduate his studies were “Once one admits to one’s own fragility, the more likely or, failing that, to provide the greatest measure of relief
directed towards the ministry, but he switched to medicine one will understand those of our fellow man.” He told his by exercise, diet, sanitary conditions and proper hygiene
entering the prestigious McGill medical school in Canada. students to learn, to see, hear, feel, smell and know that to prevent disease. One must accept the fact that there are
After several years of post-graduate training in physiology, by practice one can become an expert. Once one gains incurable diseases just as there are incorrigible vices in
pathology, neurology and dermatology he was named the the confidence of a patient and inspires him with hope the ministry and insoluble cases in the law.”
distinguished professor of medicine at McGill for six years. the battle is half won. But when a disease is incurable, (More about Dr. Osler in my September column.)
From there he went to the University of Pennsylvania as
professor of clinical medicine, where he flourished as a
teacher, clinician and consultant. He was revered by his
students for his innovative bedside instruction. Several
years later, in the most significant development of his life,
he was offered the prestigious chair of the department of ARCHIVE GALLERIES
medicine at Johns Hopkins. Under his leadership, it was
there that a new era of American medicine was born with
rigorous admission requirements and a quality of training
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