Columbia University College of Physicians and Surgeons - P and S Yearbook (New York, NY)

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x .cr .-lbore: Dr. See-gal addressing a P and 5 Club conference An effort should be made to assist each patient to feel somezchat the better for the visit, irrespective of the patientis statusf, That sentence has never left me and I have been ever grateful for that experience which has assisted me from shirking a duty and service which should be in the marrow of every physician. A recent exclamation by an eminent Greek scholar: 'cjust think, my finger prints are different from everyone elsels in the world, led me to a keener apprecia- tion of the specificity of each individual and produced a vivid recollection of a dramatic episode in my student days. Vilhen the burden of disease accentuates the uniqueness of each human being, the physician's radar apparatus receives a design unlike any he has seen before: his failure to respond appropriately makes him less than the Hgood doctor. This pattern of conduct took on special meaning during a rounds with one of my revered teachers. who was in the last stages ofa malignancy. A house ollicer tried to conserve the at- tending physit-ian's strength by suggesting that he might pass by the next patient. who had a typical right lower lobe pneumoc- occal pneumonia. Our preceptor. however. stopped short at the bedside and said: :'Ofcourse, I shall eramine the patient and listen to his chest: although I have ausculted thousands of lungs l have never heard tzco which sounded alike. Needless to say. we students were shaken by this magnificent show of courage and discipline. Our teach- er's example was not only an inspiration but served to make us appreciate the wide spectrum of clinical signs which can be produced by a single pathologic process. This perceptive bedside teacher's concern for the patient stimulated the latent clinicianship of the students. In caring for the elderly sick one's youthful diagnostic and therapeutic en- thusiasm sometimes leads to the use of inadvisable or questionable heroic meas- lflonlinued on page Bl ' 'iq' ' V 'i 'I' 'f .Q mf 4 ,- 0, - h ith '1--A ' x 1,.t , .I - l fo' ' L4 : is .-ilzore: Dr. Beatrice Seegal. Dr. David and lion cub at the Rome ZUD.

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LESS MAYBE MORE On walking by the Dean's office and hearing the first whirring of the IBM ma- chine being programmed to determine one's superannuation date, a number of past experiences take on a special clarity. It is tempting to comment on these ex- periences although one questions whether they will be of interest to others and whether the passage of time will permit ac- curate recollection. But relief comes to the oldster as he realizes that a compensa- tion of advanced age is the ability to re- member sharply the distant past although assistance is required to remember where his stethoscope has been left an hour earl- ier. The aging physician will, therefore, ac- cept the challenge of retrospection: He will even go further and since the nature of his calling encourages a degree of boldness he will not hesitate to grasp the horns of all the bulls in sight and teeter between the two epigrams of Henry Brooks Adams: 'GA teacher affects eternity, he can never tell where his influence stops. L'N0thin.g is more tiresome than a superannuated pedagoguefi Thinking back to the teaching of my preceptors in medicine, I recollect many pithy gems of advice which seem as valid today as when I first heard them years ago. Outstanding among the remembrances at this writing were those key utterances of my teachers which led me to change direc- tion, pace, or stride in the endless intel- lectual relay race, medical learning. The most meaningful and lasting educational favors had two components: They were By David Seegal brief and startlingly pertinent, thus an- ticipating Mies van der Roheis maxim 'gLess is More, and they often involved me emotionally. I well remember an instance when, as an interne, I had spent the night caring for a patient in diabetic coma and appeared on morning rounds without having prepared an adequate report on another patient under discussion. Unshaven and feeling very noble indeed for my ministrations to the diabetic girl, I apologized to the at- tending physician in tones of martyrdom for not being prepared to present an ad- equate work-up', on the second patient. I was alternately crushed and frozen when this doctor looked me straight in the eye, pointed to the bed and said: This patient is not interested in your diabetic. How right he was! I had not yet learned how to apportion my hospital responsibilities. That single sentence so electrified my clinical reflexes that when on future occasions I was about to repeat my miscalculations of time devoted to the management of multiple patients, the specter of that scene at the bedside would be recreated and haunt me. During another experience I learned a lesson in a minute or two which countless other teaching hours had failed to provide. Stopping outside a room occupied by a hopelessly ill patient, the house staff mem- ber advised the attending physician that little would be gained by the visit: there was nothing to offer the patient. The at- tending physician demurred and said that her would certainly see the patient, stating:

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Less May Be More lContinued from page 73 ures. This activity evoked the following response from one of my teachers: The principle of minimal interference is para- mount in the management of the elderly patientfi It became clear to me that the older an individual, the less his way of life should be disturbed. Interference or destruction of an established way of living may result in confusion or tragedy. The young, amorphous personality, usually can be vigorously molded without danger. In contrast, the older, more rigid person- ality is like a crystal, easily shattered by ill-considered impacts. One of my teachers, who never seemed hurried yet accomplished much, helped me to learn how to be reasonably effective in another aspect of the physician's duties. Pointing to his desk he said: As the dayis problems accumulate, I have three piles of work in front of me: first you tackle the one about which you can make immediate decisions, get it done and over with, then after appraising the second pile, contain- ing insufficient data, arrange for the col- lection ofthe required missing information, finally there is the third pile of imponder- ables which should be filed or thrown into the basket: above all, don't waste any time on themf' This program permits increased energy and time for the more important responsibilities of the day. One of the most useful sentences I was ever to hear as a medical student occurred when my preceptor and kind friend re- marked: 4'The job of the physician as a physician and educator is not just to tell but to convincef' He went on to impress us, as students, that our self-interest would be best served if we took the major re- sponsibility for active learning rather than depending upon passive teaching from out- side sources. This exhortation on the im- portance of the 'convincingi rather than the laissez-faire 'tellingl approach has been tested and proved of value through my experiences. Some of the most effec- tive teaching maneuvers directed to us as students and internes were not long, often laborious lectures but short bursts of dis- tilled wisdom, offered at an appropriate time. During one morning's rounds with a very thoughtful physician I received two pieces of advice which again illustrate the po- tential educational effectiveness of the short, arresting sentence, presented at a critical moment. In the course of the visit one of the patients bluntly asked this at- tending physician about the chances of his recovery from what appeared to be a hopeless illness. The preceptor answered the various questions masterfully without committing himself to a dire prognosis and left the patient with a ray of hope. On re- tiring from the bedside I expressed my amazement and admiration at the skilfull- ness with which the questions had been fielded to the apparent satisfaction of the patient. My teacher responded with two catalytic sentences which have become useful blocks in my own substrate of management: Before you tell the 'truthl to the patient, be sure you know the truth, and that the patient wants to hear it. Patients and their families will for- give you'for wrong diagnoses, but will lConlinued on page 841