The Second Osler Symposium - Doctoring in the 21st Century, October 20-23, 2012 in San Diego, CA

SIR WILLIAM OSLER & HIS INSPIRATIONAL WORDS

“Wilder Penfield, the eminent Canadian neurosurgeon, said of him: ‘He belongs to medical students of all time, as Lincoln belongs to the common man everywhere, a man who grew to be what he wanted by dint of hard work, and in whose footsteps any undergraduate may dare to hope and dream that he may follow.’ … The life and philosophy of William Osler continues to serve as a standard of excellence and a model for the evolution of the profession and its practitioners.” From The Quotable Osler

(The following biography is excerpted from Wikipedia, the free encyclopedia)

Sir William OslerSir William Osler, M.D., C.M., 1st Baronet (July 12, 1849 – December 29, 1919) was a Canadian physician. (The "o" in "Osler" is pronounced like the "o" in "go".) He was one of the "Big Four" founding professors at Johns Hopkins Hospital as the first Professor of Medicine and founder of the Medical Service there. (The "Big Four" were William Osler, Professor of Medicine; William Stewart Halsted, Professor of Surgery; Howard A. Kelly, Professor of Gynecology; and William H. Welch, Professor of Pathology.) Osler created the first residency program for specialty training of physicians, and he was the first to bring medical students out of the lecture hall for bedside clinical training.

He has been called the "Father of modern medicine." Osler was a pathologist, physician, educator, bibliophile, historian, author, and renowned practical joker.

Following post-graduate training in Europe, Osler returned to McGill University as a professor in 1874. It is here that he created the first formalized journal club. In 1884 he was appointed Chair of Clinical Medicine at the University of Pennsylvania in Philadelphia. When he left Philadelphia in 1889, his farewell address Aequanimitas was on the equanimity necessary for physicians.

In 1889 he accepted the position as the first Physician-in-Chief at the new Johns Hopkins Hospital in Baltimore, Maryland USA and, in 1893, he was one of the first professors of medicine at Johns Hopkins University School of Medicine. There he quickly increased his reputation as clinician, humanitarian and teacher. He presided over a rapidly expanding domain. In the Hospital's first year of operation, when it had 220 beds, 788 patients were seen for a total of over 15,000 days of treatment. Sixteen years later, when Osler left for Oxford, over 4,200 patients were seen for a total of nearly 110,000 days of treatment.

In 1905 he was appointed to the Regius Chair of Medicine at Oxford, which he held until his death. He was also a Fellow of Christ Church, Oxford. Osler was created a baronet in the Coronation Honours List of 1911 for his many contributions to the field of medicine.

Perhaps Osler's greatest contribution to medicine was to insist that students learned from seeing and talking to patients and the establishment of the medical residency. This latter idea spread across the English-speaking world and remains in place today in most teaching hospitals. Through this system, doctors in training make up much of a hospital's medical staff. The success of his residency system depended, in large part, on its pyramidal structure with many interns, fewer assistant residents and a single chief resident, who originally occupied that position for years.

He liked to say, "He who studies medicine without books sails an uncharted sea, but he who studies medicine without patients does not go to sea at all." His best-known saying was "Listen to your patient, he is telling you the diagnosis," which emphasizes the importance of taking a good history.
 
The contribution to medical education of which he was proudest was his idea of clinical clerkship — having third- and fourth-year students work with patients on the wards. He pioneered the practice of bedside teaching making rounds with a handful of students, demonstrating what one student referred to as his method of "incomparably thorough physical examination." Soon after arriving in Baltimore Osler insisted that his medical students attend at bedside early in their training: by their third year they were taking patient histories, performing physicals and doing lab tests examining secretions, blood and excreta.

He reduced the role of didactic lectures and once said he hoped his tombstone would say only, "He brought medical students into the wards for bedside teaching." He also said, "I desire no other epitaph … than the statement that I taught medical students in the wards, as I regard this as by far the most useful and important work I have been called upon to do." Osler fundamentally changed medical teaching in the North America, and this influence, helped by a few such as the Dutch internist Dr. P.K. Pel, spread to medical schools across the globe.

Osler was a prolific author and a great collector of books and other material relevant to the history of medicine. He willed his library to the Faculty of Medicine of McGill University where it now forms the nucleus of McGill University's Osler Library of the History of Medicine, which opened in 1929. Osler was a strong supporter of libraries and served on the library committees at most of the universities at which he taught and was a member of the Board of Curators of the Bodleian Library in Oxford. He was instrumental in founding the Medical Library Association in North America and served as its second President from 1901-1904.

Osler was a prolific author and public speaker and his public speaking and writing were both done in a clear, lucid style. His most famous work, 'The Principles and Practice of Medicine' quickly became a key text to students and clinicians alike. It continued to be published in many editions until 2001 and was translated into many languages. Though his own textbook was a major influence in medicine for many years, Osler described Avicenna as the 'author of the most famous medical textbook ever written.' He noted that Avicenna's Canon of Medicine remained a medical bible for a longer time than any other work. Osler's essays were important guides to physicians. The title of his most famous essay, Aequanimitas, espousing the importance of imperturbability, is the motto on the Osler family crest and is used on the Osler housestaff tie and scarf at Hopkins.

An inveterate prankster, he wrote several humorous pieces under the pseudonym "Egerton Yorrick Davis."  
Davis, a prolific writer of letters to medical societies, was purported to be a retired US Army surgeon living in Caughnawauga, Quebec, author of a controversial paper on the obstetrical habits of Native American tribes which was suppressed and unpublished. Osler would enhance Davis' myth by signing Davis' name to hotel registers and medical conference attendance lists; Davis was eventually reported drowned in the Lachine Rapids in 1884.
 
Sir William Osler died, at the age of 70, in 1919, during the Spanish influenza epidemic; his wife, Grace, lived another nine years but succumbed to a series of strokes. Sir William and Lady Osler's ashes now rest in a niche within the Osler Library at McGill University. They had two sons, one of whom died shortly after birth. The other, Edward Revere Osler, was mortally wounded in combat in World War I at the age of 21, during the 3rd battle of Ypres. According to one biographer, Dr. Osler was crushed emotionally by the loss. 
 
In 1925 a monumental biography of William Osler was written by Harvey Cushing. For this work, Cushing received the 1926 Pulitzer Prize for biography. A later and somewhat more balanced biography by Michael Bliss was published in 1999.

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Osler – Inspirations from a Great Physician was written by Charles S. Bryan and published by Oxford University Press in 1997. The chapter and section titles themselves are an outline for a balanced and honorable life…

1. Manage Time Well: Day-Tight Compartments Have Unifying Principles – Have Definite Goals – Plan the Day – Be Methodical – Take the Long View – Study Time Management

2. Find a Calling: Being True to Certain Ideals Explore the Possibilities – Be an Idealist – See the Big Picture – Know the History – Join the Organizations – Leave a Legacy

3. Find Mentors: The Young Person’s Friend Begin the Journey – Cultivate Teachers – Have Heroes – Take on Pupils – Show Gratitude – Understand the Chemistry

4. Be Positive: Prince of Friends and Benefactors Be an Optimist – Be Generous – Work – Be Decisive – Be Tolerant of Others – Use the Mature Defenses

5. Learn and Teach: Driving Plato’s Horses Value Education – Observe and Think – Combine Principles and Practice – Be Intellectually Honest – Be Both Teacher and Student – Refine the Methods

6. Care Carefully: The Least Sentimental and the Most Helpful Show Compassion – Maintain Equanimity – Touch Frequently – Care for Yourself – Keep a Sense of Humor – Care for the Right Reasons

7. Communicate: Secrets of the Heart Learn to Write – Learn to Listen – Learn to Speak – Share Concerns – Be Political – Be Careful What You Say

8. Seek Balance: A Simple and Temperate Life Be a Good Animal – Have a Family – Have Friends – Maintain Outside Interests – Answer the “Big Questions” – Be Courageous

Epilogue, Osler on Character: Pursue Virtue Virtuously

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Sir William Osler’s Words
(used to hold in place EPC’s Four Pillars that frame the symposium)

Education
More clearly than any other the physician should illustrate the truth of Plato’s saying that education is a life-long process.

A lover of good books is almost always a good [person] and usually a good citizen – but not always.

Fifteen or twenty minutes day by day will give you fellowship with the great minds of the race, and little by little as the years pass you extend your friendship with the immortal dead. They will give you faith in your own day.

It is a good many years since I sat on the benches, but I am happy to say that I am still a medical student, and still feel that I have much to learn.

Exercise
Within the past quarter of a century the value of exercise in the education of the young has become recognized. The increase in the means of taking wholesome out-of-door exercise is remarkable, and should show in a few years an influence in the reduction of the nervous troubles in young persons. The prophylactic benefit of systematic exercise, taken in moderation by persons of middle age, is very great.

Patients should have rest, food, fresh air, and exercise – the quadrangle of health.

Community
The young doctor should look about early for an avocation, a pastime, that will take him away from patients, pills, and potions . . . No [person] is really happy or safe without one, and it makes precious little difference what the outside interest may be – botany, beetles or butterflies, roses, tulips, or irises, fishing mountaineering or antiquities – anything will do so long as he straddles a hobby and rides it hard.

Linked together by the strong bonds of community of interests, the profession of medicine forms a remarkable world-unit in the progressive evolution of which there is a fuller hope for humanity than in any other direction.

I propose to consider another aspect of our work of equal importance, neither scientific nor educational, but what may be called humanistic, as it deals with our mutual relations and with the public. Nothing in life is more glaring than the contrast between possibilities and actualities, between the ideal and the real. … The desire for unity, the wish for peace, the longing for concord, deeply implanted in the human heart, have stirred the most powerful emotions of the race, and have been responsible for some of its noblest actions. It is but a sentiment, you may say: but is not the world ruled by feeling and by passion?

But do not get too deeply absorbed [in your work] to the exclusion of all outside interests. Success in life depends as much upon the [person] as on the physician. Mix with your fellow students, mingle with their sports and their pleasures. … You are to be members of a polite as well as of a liberal profession and the more you see of life outside the narrow circle of your work the better equipped you will be for the struggle.

Service
You are in this profession as a calling, not a business; as a calling which exacts from you at every turn self-sacrifice, devotion, love and tenderness to your fellow-men. Once you get down to a purely business level, your influence is gone and the true light of your life is dimmed. You must work in the missionary spirit, with a breadth of charity that raises you far above the petty jealousies of life.

We can best oppose any tendency to melancholy by an active life of unselfish devotion to others.

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Other good words…
I have an enduring faith in the men who do the routine work of our profession. Hard though the conditions may be, approached in the right spirit – the spirit which has animated us from the days of Hippocrates – the practice of medicine affords scope for the exercise of the best faculties of the mind and heart.

We doctors do not ‘take stock’ often enough.

In no relationship is the physician more often derelict than in his duty to himself.

Hilarity and good humour, a breezy cheerfulness. . . help enormously both in the study and in the practice of medicine.

Start at once a bed-side library and spend the last half hour of the day in communion with the saints of humanity.

Begin at once the cultivation of some interest other than the purely professional.

The practice of medicine is an art, not a trade, a calling not a business, a calling in which your heart will be exercised equally with your head.

I have had three personal ideals. One is to do the day’s work well and not to bother about tomorrow. … The second ideal has been to act the Golden Rule, as far as in me lay, towards my professional brethren and towards the patients committed to my care. And the third has been to cultivate such a measure of equanimity as would enable me to bear success with humility, the affections of my friends without pride and to be ready when the day of sorrow and grief came to meet it with the courage befitting a man.

… laughter is the music of life.

The conglomeration which we call society is built upon a tripod – the school-house, the hospital and the jail, which minister respectively to the manners, the maladies and the morals of man.

There is no such relaxation for a weary mind as that which is to be had from a good story, a good play or a good essay. It is to the mind what sea breezes and the sunshine of the country are to the body – a change of scene, a refreshment and a solace.

It goes without saying that no man can teach successfully who is not at the same time a student.

The dry formal lecture never, or at any rate rarely, touches the heart, but it is in [the] conversational method of the seminar, or in the quiet evening at home, with a select group and a few good editions of a favorite author, that the enthusiasm of the teacher becomes contagious.

It helps a man immensely to be a bit of a hero-worshipper, and the stories of the lives of the masters of medicine do much to stimulate our ambition and rouse our sympathies.

…let me congratulate you on the choice of calling which offers a combination of intellectual and moral interests found in no other profession … a combination which, in the words of Sir James Paget, ‘offers the most complete and constant union of those three qualities which have the greatest charm for pure and active minds – novelty, utility, and charity.’

The aim of a school should be to have these departments in the charge of men who have, first, enthusiasm that deep love of a subject, that desire to teach and extend it without which all instruction becomes cold and lifeless; secondly, a full personal knowledge of the branch taught; not a second-hand information derived from books, but the living experience derived from experimental and practical work in the best laboratories. … Thirdly, men are required who have a sense of obligation, that feeling which impels a teacher to be also a contributor, and to add to the stores from which he so freely draws.

There is a form of laughter that springs from the heart, heard every day in the merry voice of childhood, the expression of a laughter -- loving spirit that defies analysis by the philosopher, which has nothing rigid or mechanical in it, and totally without social significance. Bubbling spontaneously from the heart of child or man.

It cannot be too often or too forcibly brought home to us that the hope of the profession is with the men [and women] who do its daily work in general practice.

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.

Now the way of life that I preach is a habit to be acquired gradually by long and steady repetition. It is the practice of living for the day only, and for the day's work.

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