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

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THE IVORY TOWER Y DROME When some time ago I accepted the flattering invitation to write something for this Year Book, I promised myself that I would avoid rhetoric and slogans. and that I would try to discuss some topic pertaining to our daily life. This led me to the decision of writing about an interesting syndrome. This is a disease which is endemic in most important medical and teaching institutions. The disease. or syndrome. is not sex linked and is not limited to any age group. It is probably con- tagious. but the exact method of transmission is not known. We can call it the Ivory Tower Syn- drome. The patients who become affected by it may look perfectly normal except when they speak or write on topics pertaining to their field or speci- alty. A trained and keen observer will then detect the following symptoms: the patients become dog- matic and ignore, or at least disregard entirely. any opinion, point of view. research method or results. which originated in other institutions. They con- sider reliable and important only the results and conclusions reached by them or their group, Un careful interviewing, their rationalization goes somehow along these lines: a. This is one of the greatest medical and scientific centers: b, I belong to it lor it belongs to met: c. We have at- tained. or are near attaining, excellence in our field: d. Ergo, those who disagree with us must by neces- sity be wrong and misguided and we need not waste our time by paying attention to what they say. The By Raffaele Lattes Ivory Tower Syndrome is not a rare disease. With some experience. it can be diagnosed easily. It is apparent that while early detection can be of great help in combatting it by isolating the patients, adequate prevention is possible and more desirable. What was said above was not meant to imply that in the biological and medical sciences the opinions of a mediocre majority should prevail on those of one outstanding individual. What was meant is that' we must study and respect the opinions and results reported by others in our field, and try seriously to understand the reasons for the discrepancies that may exist between our point of view and theirs. For instance, one of the blandest manifestations of our syndrome is our frequent tendency to ignore the foreign literature. First rate basic and clinical research is done abroad as well as here. just as poor articles are published here as well as abroad. If we acquaint ourselves with what has been done and reported elsewhere, not only will we avoid reporting as new. observations already made and published by others, but we will without fail see our own field or specialty in a better perspective. In my opinion, the road to excellence is paved not only with hard work and superior intellectual ability. It also requires understanding and tolerance of other points of view. and thorough familiarity with work done by others. Without this, we run the risk to march down a path leading to narrow minded- ness and arrogance.

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games in medicine is the making of snap diag- noses at the bedside. A diagnosis of this kind almost invariably generates an emotional at- tachment, and such emotion impairs a reasoned judgment based on subsequently acquired facts. Finally, good clinical judgment is dependent upon an ability to organise rationally all the known data about a pa- tient, giving proper rela- tive weight to what may appear to be conflicting facts and distinguishing important information in ' . I Y a mass of irrevelancies. X 5 The fourth essential is dj honesty in dealing with Fx' associates. One would think it superfluous to E W. ..... mention this, were it not for the fact that occasion- , is ally an interne may tell F an inquiring attending T physician that a patient could not have a carci- noma of the rectum when in fact he has not done a rectal examination-though he will do it im- mediately after rounds to confirm his statement. This is not honest, and the practice of good ward medicine is impossible when it occurs. The jifth quality is compassion. Compassion must be present in most of you or you would not now be physicians. This. also, cannot be im- parted by instruction, but it is hoped that the example of the teacher has been such that you have observed the difference that compassion can make to the well-being of the patient. s as Iil N M 1 However, the quality which most frequently seems to distinguish the superior from the med- iocre interne is the ability to pay meticulous at- tention to detail. The good interne knows every- thing about the patient's personal and medical historyg the bad interne invariably fails to know some point which is crucial to the management of the patient. The good in- terne has done a complete and accurate physical ex- amination and has prop- erly interpreted his find- ingsg the bad interne has invariably either failed to perform some important part of the physical exam- , - r ination or to interpret K Qs. properly his findings. The good interne has sudicient intellectual curiosity to j acquire more and perti- nent information about the patients disease: the - - had interne invariably has not. The importance of paying conscientious and meticulous attention to detail in the manage- ment of patients cannot be over-einphasized. Without it, intelligence is wasted, factual knowl- edge is worthless. reasoned judgment is impos- sible, honesty is irrelevant, and compassion is fraudulent. The perfect interne has probably never existed, and probably never will. The respon- sible interne, however, is not too distant a figure for your aspiration and endeavour. May I wish all of you the best as you take up your new duties.

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The Class 0f1964 College of Physicians and Surgeons