Rural Practice, Country Doctors, Family Doctors

More about the man and the relevance of his work to modern medical education even today! http://www.mja.com.au/public/issues/171_11_061299/orourke/orourke.html

Osler, Alabama, and Harrison (Medicine Text) Includes picture of Osler and Harrison http://www.sma.org/smj2001/julysmj01/dalton.pdf

Review of Bliss book on Osler http://www.oslerbooks.com/pdf/oslerblissreview.pdf

The Best Profession to Choose

Have no higher ambition than to become an all-round family doctor, whose business in life is to know disease and to know how to treat it. "The Student Life: A Farewell Address to Canadian and American Medical Students." Medical News, New York, 87:625, 1905.

The cultivated general practitioner. May this be the destiny of a large majority of you!…You cannot reach any better position in a community; the family doctor is the man behind the gun, who does our effective work. That his life is hard and exacting; that he is underpaid and overworked; that he has but little time for study and less for recreation–these are the blows that may give finer temper to his steel, and bring out the nobler elements in his character. "The Student Life: A Farewell Address to Canadian and American Medical Students." Medical News, New York, 87:625, 1905.

The modest country doctor may furnish you the vital link in your chain, and the simple rural practitioner is often a very wise man. Thayer, W. S., "Osler, the Teacher," Johns Hopkins Hospital Bulletin, 30:198, 1919.

"The small town needs the best and not the worst doctor procurable. For the country doctor has only himself to rely on: he cannot in every pinch hail specialist, expert, and nurse. On his own skill, knowledge, resourcefulness, the welfare of his patient altogether depends. The rural district is therefore entitled to the best-trained physician that can be induced to go there."  This quote was a Flexner, the other guy of the time, not an Osler

The Requirements of Family Practice

I would speak of [the general practitioner’s] failure to realize first the need of a lifelong progressive personal training, and secondly, the danger lest in the stress of practice he sacrifice that most precious of all possessions, his mental independence. "Chauvinism in Medicine," Montreal Medical Journal, 31:684, 1902.

In no profession does culture count for so much as in medicine, and no man needs it more than the general practitioner. "Chauvinism in Medicine," Montreal Medical Journal, 31:684, 1902.

Beware of Specialism

No more dangerous members of our profession exist than those born into it, so to speak, as specialists. Without any broad foundation in physiology or pathology, and ignorant of the great processes of disease, no amount of technical skill can hide from the keen eyes of colleagues defects which too often require the arts of the charlatan to screen from the public. "Remarks on Specialism," Boston Medical and Surgical Journal, 126:457, 1892.

The incessant concentration of thought upon one subject, however interesting, tethers a man’s mind in a narrow field. "Chauvinism in Medicine," Montreal Medical Journal, 31:684, 1902.

By all means, if possible, let [the young physician] be a pluralist, and–as he values his future life–let him not get early entangled in the meshes of specialism. "Internal Medicine as a Vocation," Medical News, New York, 71:660, 1897.

There are, in truth, no specialties in medicine, since to know fully many of the most important diseases a man must be familiar with their manifestations in many organs. "The Army Surgeon." Medical News, Philadelphia, 64:318, 1894.

Beware of the Delilah of the Press

In the life of every successful physician there comes the temptation to toy with the Delilah of the press–daily and otherwise. There are times when she may be courted with satisfaction, but beware! Sooner or later she is sure to play the harlot, and has left many a man shorn of his strength, named the confidence of his professional brethren. "Internal Medicine as a Vocation," Medical News, New York, 71:660, 1897.

Believe nothing that you see in the newspapers–they have done more to create dissatisfaction than all other agencies. If you see anything in them that you know is true, begin to doubt it at once. Bean, R. Bennett, Oslerismn, An unpublished collection of Sir William Osler’s bedside epigrams, 1903-5.

Doubtless as an exclusive dietary the press and magazine do lead to mental conditions and counterpart of what we know in the body as deficiency diseases, scurvy, rickets, etc. The library…supplies the vitamins which counteract the mental lethargy and anemia which come from a too exclusive use of…patent foods. "The Library School in the College," Library Association Record, London, 19:287, 1917.

About Learning Medicine

The hardest conviction to get into the mind of a beginner is that the education upon which he is engaged is not a college course, not a medical course, but a life course, for which the work of a few years under teachers is but a preparation. "Influence of Louis on American Medicine," Johns Hopkins Hospital Bulletin, 8:161, 1897.

Except it be a lover, no one is more interesting as an object of study than a student. "The Student Life: A Farewell Address to Canadian and American Medical Students." Medical News, New York, 87:625, 1905.

"To study medicine without books is to sail an uncharted sea, while to study medicine only from books is not to go to sea at all." Sir William Osler   More on Vast and Endless Sea

Personally I have always been opposed to that base and most pernicious system of educating them with a view to examinations, but even the dullest learn how to examine patients and get familiar with the changing aspects of the important acute diseases. Osler

Let not your conceptions of the manifestations of disease come from words heard in the lecture room or read from the book. See, and then reason and compare and control. But see first. No two eyes see the same thing. No two mirrors give forth the same reflection. Let the word be your slave and not your master. Live in the ward. Thayer, W. S., "Osler, the Teacher," Johns Hopkins Hospital Bulletin, 30:198, 1919.

The good observer is not limited to the large hospital. Thayer, W. S., "Osler, the Teacher," Johns Hopkins Hospital Bulletin, 30:198, 1919.

Half of us are blind, few of us feel, and we are all deaf. Bean, R. Bennett, Oslerismn, An unpublished collection of Sir William Osler’s bedside epigrams, 1903-5.

Do not waste the hours of daylight in listening to that which you may read by night. Bean, R. Bennett, Oslerismn, An unpublished collection of Sir William Osler’s bedside epigrams, 1903-5.

Undoubtedly the student tries to learn too much, and we teachers try to teach him too much–neither, perhaps, with great success. "After Twenty-Five Years," Montreal Medical Journal, 28:823, 1899.

To cover the vast field of medicine in four years is an impossible task. "After Twenty-Five Years," Montreal Medical Journal, 28:823, 1899.

The training of the medical school gives man his direction, points him the way, and furnishes him with a chart, fairly incomplete, for the voyage, but nothing more. Osler

The important thing is to make the lesson of each case tell on your education. The value of experience is not in seeing much, but in seeing wisely. "The Army Surgeon." Medical News, Philadelphia, 64:318, 1894.

In taking histories follow each line of thought; ask no leading questions; never suggest. Give the patient’s own words in the complaint. Bean, R. Bennett, Oslerismn, An unpublished collection of Sir William Osler’s bedside epigrams, 1903-5.

If we ever are to give our third- and fourth-year students protracted and complete courses in physical diagnosis and clinical medicine, extending throughout the session, and not in classes of a brief period of six weeks’ duration, I am confident that the number of men engaged in teaching must be greatly increased. "Internal Medicine as a Vocation," Medical News, New York, 71:660, 1897.

I have learned since to be a better student, and to be ready to say to my fellow students "I do not know." Bean, R. Bennett, Oslerismn, An unpublished collection of Sir William Osler’s bedside epigrams, 1903-5.

But for the majority, daily contact with students, and a little of the routine of teaching, keep us in touch with the common clay and are the best preservatives against that staleness so apt to come as a blight upon the pure researcher. "The Hospital Unit in University Work," Lancet, 1:211, 1911.

A physician who treats himself has a fool for a patient. Bean, R. Bennett, Oslerismn, An unpublished collection of Sir William Osler’s bedside epigrams, 1903-5.

Humanity has but three great enemies: fever, famine, and war; of these by far the greatest, by far the most terrible, is fever. Cushing, Harvey. Life of Sir William Osler, Oxford, Clarendon Press, 1926.

 

More Information on Osler

and bibliography and further quotes as collected by Robert Bennett Bean, M.D. (1874-1944) and edited by William Bennett Bean, M.D. from site at http://www.vh.org/Providers/Publications/osler/foreword.html

 

Best Quotes in Rural Medical Education

Francis W. Peabody wrote:

In the trend toward specialism the pendulum is swinging too far, and it is the duty of medical educators and leaders to indicate to their students the importance of general practice and the high professional attainments that are necessary for success in it. But this alone will not suffice. In the last analysis it is the attitude of the public which will determine the careers of many of our future medical men. If the public will but realize that it can have no greater asset than a close and continued personal relationship with a wise, sound, general adviser, it may rest assured that there will always be an adequate response to the call for service. In order to get the best type of medical men to turn to general practice, however, it is necessary for the public to understand that the qualifications for general practice are at least as high as those which are requisite for specialism, and to appreciate that the general practitioner is worthy of its respect and confidence.

From "The Public and the General Practitioner," written in the 1920s.

The challenges we face in family medicine now are not new, although now at least the "we" thankfully includes many women.  Thanks,

Dan  VinsonD@health.missouri.edu 

 

More on Specialist vs Generalism, from the Lay Press: Doctor's Advice
A patient was waiting nervously in the examination room of a famous specialist.
"So who did you see before coming to me?" asked the doctor.
The patient answered, "My local General Practitioner."
"Your GP?" scoffed the doctor. "What a waste of time! Tell me, what sort of useless advice did he give you?"
"He told me to come and see you."
When you mock and debase others you lower yourself.

from Pastor Tim's Illustration List  http://www.cybersaltlists.org  as noted in Sermon_Fodder by Keith Todd <ktodd@vci.net>

I was playing "Operation" with my daughters last night. This game has been around since before I can remember. Did you know that there are two types of cards, one set that is labeled "Doctor" and one set labeled "Specialist". If you pick the "Specialist" card you get double the fee for the same procedure as if you just pick a "Doctor" card. This is really culturally ingrained.... I explained to them that, in fact, we all get the same reimbursement for the same procedure - they had to know the truth.... By the way, I think the game is much harder than real surgery. Stephen McKernan, DO

 

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