Duke University School of Medicine - Aesculapian Yearbook (Durham, NC)

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S URGERT Surgery is not a single science, but the application of many to the management of disease, injury or deformity whose course can be altered to the patient's advantage by an operation or some other mechanical procedure. Manual dexterity and meticulous attention to the details of operative technique, though important, are subordi- nate to a precise understanding of the pathology of the living with all of its anatomic, physiologic, chemical, biologic and humanistic implications. A surgeon must be able to recognize disease processes in all stages of their development and in all of their atypical manifestations. He must know which of these might be benefitted by an operation and when the proper time for surgery may have arrived. He must know how best to prepare his patient to undergo the ordeal of sur- gery and which technical procedure is best adapted to the needs of the patient. He must conduct the operation with gentleness and dispatch with strict attention to the principles of wound healing and the physiology of the structures he repairs. And after the operation, he must understand how to care for the deranged biologic proc- esses to insure safe convalescence. In the case of emergencies, he must be able to accept responsibility, make decisions and carry out an active course of treatment, often unassisted, alone and in the small hours of the night when undue meditation, inde- cision, or procrastination might lead to loss of life. He, then, has the advantage of verifying his diagnosis imme- diately on the operating table. Rarely in surgery does one have to wait long, one way or another, to learn whether his judgment was correct or fallacious. And any surgeon with a conscience who is not humble under these circumstances is a poor surgeon indeed. Specialization has narrowed the held of activity of Du. CiARDNER many surgeons who now limit themselves to a specific area or group of organs. Yet no one needs broader training, closer orientation to the entire Held of medicine, or understanding of the workings of the body as a whole more than the specialistg for the fundamental laws of all the biologic sciences operate in his field with the same inflexible regularity as in any other, and disease processes, injuries or an assassins bullets know no specialty barrier in the area they cover. The present day surgeon can no longer be looked .. LY 9 an W- 4 X Du. Gm' L. Onom DR. WILLIAINI ANLYAN DR. LEONARD GoLDNER lulenty-eight

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MEDICI The Department of Medicine traditionally has the responsibility of preparing the student for a lifetime of learning as he gives care to patients who ask him for help. The first step is to begin to think and act like a doctor. Two courses in the second year, Introduction to Clinical Practice and Clinical Microscopy, prepare the student so that he can take an active role in patient care. ln the third and fourth years, the student assigned to Medicine acts in the role of a physician. His desire to give good care is the motive which drives him to excellence. He learns to properly identify the problems of the patient. Having identified the problems, he marshalls the information which he can bring to bear on them by his pzlSt training, he recognizes the gaps in his knowledge as he attempts to focus the information learned from the basic sciences onto the specific clinical problem. Using the patient as his means of integration, he re-reads his anatomy, physiology, microbiology, phar- macology and biochemistry. In this clinical setting he has the opportunity to speak many Words which he has previously only read, he discusses the problem with his fellow students, interns, resident and senior staff, he gains familiarity with ideas and concepts by actively manipulating them. The student crystallizes out his idea of the best diag- nostic and therapeutic approach to this particular patient. He identifies the reasons for each of these decisions. He has real curiosity to see if his evaluation of the situation is correct or if he will have to admit that certain data which he interpreted as rock-like support for his house of cards have turned out to be shifting sand. He learns that the course of biology is uninfluenced by strong state- ITICIIIS, by the rank of the faculty member, or by the number of supporting references not quite applicable to the points in question. W 1 DR. STEAD Under guidance from his fellow students and from faculty of all ranks, he slowly appreciates the difficulties of learning in this system of multiple variables operating on only partially defined substrates. Part of a doctor's learning is only experiential. He knows from living with his patients that certain things are possible, but he does not know the underlying sequence of events. In other instances, his learning is more precise because he understands and can control some of the important variables. He must learn both the liabilities and virtues of attempting to use logic in clinical practice. The goal of the Department of Medicine is for the Dia. Wii.i.1Aixi Nici-ioLsoN Du. HAIRVEY ESTES DR- EDWARD S- ORGAIN