Friday, April 27, 2007

Last Class

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.

Today was the last academic requirement of my medical school career. It wasn't particularly taxing, simply my final meeting with the professor guiding my last month of reading, but it was rewarding. I had finished reading the two biographies of Osler, along with a volume of his essays and speeches, and then I closed this month of Osler-mania by reading the man's favorite book, Religio Medici, by Sir Thomas Browne.

Much of Osler's writing is directed towards medical students, so in reading his works, I regretted not discovering him sooner. (And if you're a medical student or about to be one, you should drop everything and read Aequanimitas and The Student Life today.) But Thomas Browne is not writing to anyone at all, the work is a sort of confession, as he explores his thoughts on God and life. It is also highly worth reading, and though some parts of it are quite dated, the charitable reader will find much to learn from. Browne was a physician in England, who wrote his book in 1635 (though it wasn't published until later) just before he turned 30. At this point in his life, he had learned 6 languages and studied medicine in all the great schools of Europe. But the book is much more about his relations with God and man than with his profession.

Returning from Browne to Osler, it is easy to see the echoes of the great 15th century doctor in his protege 300 years later. Many of the same thoughts, much of the same style. It is easy, reading him, to see why Osler would state "No other profession can boast of the same unbroken continuity of methods and of ideals. We may indeed be justly proud of our apostolic succession." If the profession is deep, it is also broad, and Osler would say in another place "medicine is the only world-wise profession, following everywhere the samee methods, actuated by the same ambitions, and purpusing the same ends." Both these ideas can been seen, nascently, in Browne.

My question after finishing this three thousand odd pages of reading (two biographies, two collections of essays, and Religio Medici) was "where to now?" Osler brought the "Jovian and God-like" image of the physician in antiquity into the modern era, demonstrating its continuance in a scientific world. But he finished his practice before antibiotics, before most diseases could be cured, and before the era of "informed consent." How does a physician today take the lessons of Osler and transfer them to a modern world? I have reached the end of a class, but not the end of my learning.

My professor's answer was straightforward. Francis Peabody, MD was a member of the generation of medical students growing up under Osler's influence, and he lived long enough to see the new ideas and conflicts start to arise. He wrote an essay called "The Care of the Patient" which at least framed these questions, taking the philosophy of Oslerian medicine and working it into the new world. It is, apparently, worth much more than the famous closing line "for the secret of the care of the patient is in caring for the patient." So I haven't run out of reading material.

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