UNIVERSITY OF VANDERBILTUNIVERSITY OF VANDERBILTSCHOOL OF MEDICINESCHOOL OF MEDICINE

A PHILOSOPHY OF MEDICINE : LESSONS WE AND

OUR PATIENTS HAVE RECEIVED WITH GRATITUDE

H. Cecil Coghlan, MD,FACC. Professor of Medicine

University of Alabama at Birmingham

First Edition of Principles of

Internal Medicine

1951

MedicalMedicalHistoryHistory

T. R. HarrisonPaul B. Beeson

William H. ResnickGeorge W. ThornM. M. Wintrobe

IntroductionIntroductionApproach to the PatientApproach to the Patient

►No greater opportunity, responsibility, or No greater opportunity, responsibility, or obligation can fall to the lot of a human being obligation can fall to the lot of a human being than to become a physician. In the care of the than to become a physician. In the care of the suffering he needs technical skill, scientific suffering he needs technical skill, scientific knowledge, and human understanding. He who knowledge, and human understanding. He who uses these with courage, with humility, and uses these with courage, with humility, and with wisdom will provide a unique service for with wisdom will provide a unique service for his fellow man, and build an enduring edifice of his fellow man, and build an enduring edifice of character within himself. The physician should character within himself. The physician should ask of his destiny no more than this; he should ask of his destiny no more than this; he should be content with no less. be content with no less.

T. R. Harrison, Principles of Internal Medicine, 1951

APPROACH TO THE PATIENTAPPROACH TO THE PATIENT

► In the practice of medicine the In the practice of medicine the physician employs a discipline which physician employs a discipline which seeks to utilize scientific methods and seeks to utilize scientific methods and principles in the solution of its principles in the solution of its problems, but it is one which, in the problems, but it is one which, in the end, remains an art, in the sense that end, remains an art, in the sense that rarely, if ever, is it possible to exclude rarely, if ever, is it possible to exclude judgment and experience from the judgment and experience from the interpretation of the patient’s interpretation of the patient’s reactions. reactions.

T. R. Harrison, Principles of Internal Medicine

Words of WisdomWords of Wisdomfrom “ The Chief “from “ The Chief “

RE- SEARCH : “ cooking the scraps of other’s fare “

Versus

PRE- SEARCH : “ blazing new trails for the humanmind”

T. R. Harrison, 1974

Left Ventricular Function.Left Ventricular Function.O. Frank., Z. Biol., 1895; 32: 370O. Frank., Z. Biol., 1895; 32: 370

Response of the frog ventricle

To increased filling pressure

Professor Tinsley

Randolph Harrison

1900-1978

PHILOSOPHY OF EDUCATIONPHILOSOPHY OF EDUCATIONEDUCATIONAL EQUATIONSEDUCATIONAL EQUATIONS

TINSLEY R. HARRISON , M.D.TINSLEY R. HARRISON , M.D.

►“ “ Such modest abilities as I may have as a Such modest abilities as I may have as a teacher are the consequence of an teacher are the consequence of an educational philosophy arrived at by the educational philosophy arrived at by the fortunate combination in William Osler of a fortunate combination in William Osler of a clear head and a warm heart. The training clear head and a warm heart. The training of a pupil may be compared to the rearing of a pupil may be compared to the rearing of a child. The best assurance that a of a child. The best assurance that a teacher has of achieving his objective is to teacher has of achieving his objective is to attempt to be the kind of person he wishes attempt to be the kind of person he wishes his pupil to become “his pupil to become “

EDUCATIONAL PHILOSOPHYEDUCATIONAL PHILOSOPHYTinsley R. HarrisonTinsley R. Harrison

► The training of a physician is both similar to and The training of a physician is both similar to and different from the training of an engineer. For both, the different from the training of an engineer. For both, the precise thinking derived from quantitative precise thinking derived from quantitative measurements and from scientific principles is essential. measurements and from scientific principles is essential. But because the physician does not deal with inert raw But because the physician does not deal with inert raw materials and only secondarily with machines but rather materials and only secondarily with machines but rather with people, impaired by disease, afflicted by suffering, with people, impaired by disease, afflicted by suffering, and hampered by fear, even the finest and clearest and hampered by fear, even the finest and clearest scientific thinking is not enough. Like the minister, the scientific thinking is not enough. Like the minister, the priest or the rabbi, the physician needs a deep and priest or the rabbi, the physician needs a deep and pervading humanity. It does not seem an insuperable pervading humanity. It does not seem an insuperable task for our medical schools to train physicians that can task for our medical schools to train physicians that can think like engineers and feel like ministers think like engineers and feel like ministers

Educational equations inspired by Educational equations inspired by Albert EinsteinAlbert Einstein

E = h H2E = h H2 E= education, h = teacher’s head, H = teacher’s HEARTE= education, h = teacher’s head, H = teacher’s HEART

E = mc2E = mc2 E = education, m = mental interaction between teacher E = education, m = mental interaction between teacher

and pupil, c = mutual, partial cardiac transplantation.and pupil, c = mutual, partial cardiac transplantation.

“ “ If a teacher leaves behind him pupils and pupil’s pupilsIf a teacher leaves behind him pupils and pupil’s pupils

whose hearts are warm, whose minds are fertile and whose hearts are warm, whose minds are fertile and whose goals are high, he has not lived in vain”whose goals are high, he has not lived in vain”

““Support “Support “

► “ “ Never forget that we physicians can cure Never forget that we physicians can cure sometimes, but must comfort always “ ( T. R. sometimes, but must comfort always “ ( T. R. Harrison )Harrison )

► The patient said softly: “ My doctor’s love is as The patient said softly: “ My doctor’s love is as important to me as his chemotherapy “. For a long important to me as his chemotherapy “. For a long time, I had carried the belief that, as a physician, my time, I had carried the belief that, as a physician, my love didn’t matter and the only thing of value I had love didn’t matter and the only thing of value I had to offer was my knowledge and skill. I now realized to offer was my knowledge and skill. I now realized that medicine is as close to love as it is to science, that medicine is as close to love as it is to science, and its relationships matter even at the edge of life and its relationships matter even at the edge of life itself. ( R. N. Remen, Kitchen Table Wisdom , 1996 )itself. ( R. N. Remen, Kitchen Table Wisdom , 1996 )

A Spanish ProverbA Spanish Proverb

►Make sure you never forget that Make sure you never forget that the the

“ “ devil “ knows so much, not devil “ knows so much, not because he is a devil, but because because he is a devil, but because he has been around for so long.he has been around for so long.

Albert Einstein

in his studyin Princeton

1939 “ The

important thing is tonever stop

asking questions “

THE PRACTICE OF MEDICINETHE PRACTICE OF MEDICINET. R. Harrison, Principles of Internal T. R. Harrison, Principles of Internal

MedicineMedicine

►Tact, sympathy and understanding Tact, sympathy and understanding are expected of the physician, for are expected of the physician, for the patient is no mere collection of the patient is no mere collection of symptoms, signs, disordered symptoms, signs, disordered functions, damaged organs, and functions, damaged organs, and disturbed emotions. He is human, disturbed emotions. He is human, fearful, and hopeful, seeking relief, fearful, and hopeful, seeking relief, help and reassurance.help and reassurance.

THE PRACTICE OF MEDICINE: PHILOSOPHY THE PRACTICE OF MEDICINE: PHILOSOPHY UPDATE 2006UPDATE 2006

► Patients serve as a unique scientific resource. They Patients serve as a unique scientific resource. They report what is wrong, we have to make sense of report what is wrong, we have to make sense of what they teach. They tell us the truth; we have to what they teach. They tell us the truth; we have to avoid dismissiveness as a defense of our own avoid dismissiveness as a defense of our own ignorance. They seek our help; we have to ignorance. They seek our help; we have to commiserate with their unintended, unwanted commiserate with their unintended, unwanted metamorphosis from independent, private, metamorphosis from independent, private, integrated personhood to dependent, exposed, integrated personhood to dependent, exposed, disintegrated patienthood. disintegrated patienthood.

David S. Goldstein, M.D., Ph. D., Adrenaline and the Inner World. An David S. Goldstein, M.D., Ph. D., Adrenaline and the Inner World. An introduction to Scientific Integrative Medicine. The Johns Hopkins introduction to Scientific Integrative Medicine. The Johns Hopkins University Press, 2006. University Press, 2006.