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

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Dr. Raffaele Lattes and Dr. Donald Tap- ley are outstanding as gentlemen and scholars. Their stress of logical analysis and clear thinking has generated enthus- iasm for their respective endeavors. They are faithful friends, fair-minded critics and sympathetic advisers. The Class of 1964 dedicates the Yearbook with great appreciation and deep respect to Dr. Lattes and Dr. Tapley. 3

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THE RESPGN IBLE INTERNE The suggestion of your Yearbook Committee that I write something about the philosophy un- derlying the third year clerkship in medicine appeared somewhat retrospective. Since all of you are about to embark on an internship as the next step in your career, it seemed to me that it might be more appropriate to try to define that rather nebulous figure, the responsible interne. During your last two years in medicine you have gradually assumed more and more respon- sibility for the management of patients. But you have not yet assumed the entire responsibility for a sick person. The successful undertaking of this responsibility is a pritical step in your de- velopment as physicians. Certain qualities, dis- tinguishing the excellent from the mediocre in- terne, seem requisite for success. The hrst essential is a reasonable intelli- gence. All of you have this, or you would not have competed successfully for admission to medical school. The mere possession of such native intelligence, however. does not necessarily insure its proper use. ln the third year clerkship great emphasis was placed upon the logical and scientific analysis of all the facts known about a patient so that one might learn to use this intelli- gence in an appropriate and effective fashion. The second essential is an adequate fund of factual knowledge about the pathophysiology of disease. Throughout your first two years at medical school you were presented with a large body of such knowledge. This process has con- tinued during your clinical years, but at a pace conditioned by your increasing assumption of BY DONALD TAPLEY responsibility. In the third year clerkship some of you were perhaps disappointed by the rela- tively less concentrated diet of facts provided by the faculty. Medical facts, however, are fre- quently transientg a knowledge of how to keep up with advances in medicine through an appro- priate use of books and journals is in the long run a more valuable asset. The third and most important requirement I have chosen to call judgment. This is perhaps the most difficult of all for the faculty to impart to students, and is perhaps best taught by exam- ple. Good judgment in the appraisal and man- agement of a patient is not necessarily directly correlated either with the fund of factual knowl- edge or with the native intelligence which the interne possesses. Both, of course, are essential but some of the most intelligent internes have the poorest clinical judgment. Rather, good judg- ment may be correlated with more elusive qual- ities: intellectual honesty, humility, compassion, and the ability to organise. To be honest intel- lectually is to admit to yourself your areas of ignoranceg to give full weight in your thinking to facts which disagree with your preconception of the patient's problems and to make careful distinction between those diagnostic and thera- peutic procedures which are essential to the man- agement of the patient and those which are de- signed simply to satisfy your intellectual cur- iosity. To be luunble is to admit the fallibility of your most cherished diagnosis, and be willing to re-evaluate your position and your approach as new facts emerge. One of the most dangerous