SUNY Downstate Medical Center - Iatros Yearbook (Brooklyn, NY)

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Mes, , '.-H A - ' lf- f , , , ,, , , , , 3 fFf 'H ,vw 575 7'f 'T' dm 7 A, ,f ' l,,L'Q':l'7 ' Vik, lr ' i uf T .lf Y, . TYYQW, W Y jf l:f'v ff' W ' TLV LT , ' 7 ,Z 'ffff ,Q A . . W . 7 - X . , K ,A rk.U.JQ-,Ci I as ein! , ,rs-a ., ,-,,s:--,,z,,-- . ,C-17,7 ls'1.f x. . Ill 'l : .:tf'il?'9gi,:'f tif' s 'f should do away with the specialist but let us try to inculcate into him not only scientihc zeal for greater detail of knowledge but also a philosophic outlook which will aid hi1n to relate his particular Work to the rest of the patient's diseased body and also 'to the personality which is simultaneously altered. Such a physician can be called a 'ctotalistf' even though his area of medical practice be restricted or spe- cialized. The outstanding examples of totalism can be found in that fast vanishing race of family doctors whose fame has been sung in many an old story and whose magic touch has healed many a bruised spirit or suffering body in this room. He was not a scientihc biologist. He was a medical philosopher. He knew the heritage of his patients and many of the environmental factors which had a bearing on their pres- ent troubles. Let us grant that his scientific armamentorium was scanty and maybe inadequately usedg that he muddled through major surgery and complicated obstre- trics, with occasional dire results to his patients. Nevertheless, we must face the fact that he played a noble part in human living because of his broad outlook on his patients as individuals whose bodies, minds and spirits needed help. W e are ajlictefl by what we can prove, We are flistraclecl by what we know So, ah so! Down. from your heavens or up from your mold, Send us the hearts of our fathers of old. It is improbable that the old family doctor who assumed entire charge of all of his patients will be with us long. The public whom he served has come 'to de- mand- thanks to the effort of the profession itself, more scientific knowledge than he is able to possess. His place will probably be hlled by men and Women who have inherited some of his qualities of mind and soul in that they are 'ctotalistsn yet who recognize more clearly than did he, their specihc and technical limitations and who will call for specialized help in the handling of their problems. These practitioners of general medicine may continue to travel alone or they may more or less formally associate with themselves, specialists whose medical philosophy is akin to their own. Such a group naturally finds its focus in a hospital, where its internal organization need not be sharply defined. In many communities there already are even more closely knit bodies of physicians, whose offices and practices are managed as a corporate entity. The guiding spirit in either of these types of co-operative effort is the successor of the family doctor, who marshals the facts and guides the patient,s course. The broader the specialist's outlook the closer harmony there is within the unit. The success of these groups, be they small or involved, related primarily to the individualis illness or to the community's Well- being, will depend not only on the scientific skill which is displayed, but upon the individualization of their patients. How can we prepare this type of physician-this doctor whose interest is as much in the man as in the microbe. In the hrst place, great care must be exercised in the selecting of the individual medical student. Not only should there ,be a thorough study of his intellectual attainments, as exemplified in past scholastic endeavor, but also all possible light must be brought to bear on his character and ll i c 'gg , his so --,i..ii s, Turf

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4.1 451-3535. L :HQ -yvl41. fI -,, liar ci, 1 f. ...Z 1 .. cr., . Q . .,, .Y . ,..,, , ,..Y..s of V :ax .lilfyy-.-.in .Y -,lg-L-g T? -:B-5:1-X-1. fi ,.:,::g:a.-.!f is mas- J-2 - 1--iifag Y- ---2221?--f ' JN. 1 , ,-'E- alfa-. .Q 1.14-,2LL:f:i' 'H 7. 111- IE.-,.1 x if' 1 , ----J-------------------H -v -- ---mf.-, .v ,.1f,1 - ,4,.,. --.M . . .,... ,,.......,....Y,--...-,, ' L, -,-i. -' 1' N -'rf' I- , tg' The Unit of Medical Service FRANK L. BABBOTT, JR. President, Long Island College of Medicine N one of his masterfully simple and stimulating sermons Dr. Harry Emerson Fos- dick referred to a man who possessed a marvelous watch. Not only would it tell the hour of the day, but thanks to its delicate machinery it would record the day of the week, the day of the month and the phases of the moon. its ability to succeed in such vast matters, however, depended entirely on how faithfully and accurately it told off the seconds of each minute. That was its unit of service. When it failed there, all else became awry. Society has in its hands a similarly intricate and complicated watch- the medi- cal profession. It points with just pride to its far-flung and wide-open hospitals, to its huge centers or clinics, to its industrial health services, to its naftion-and even world-Wide health movements. It shouts about the numbers of cases treated. Yet only insofar as its minimum unit of service is properly and wholly rendered can any of the vast agencies be counted on to do their real part. This unit is the coni- plete man, woman or child. If this well man, as an entity can be kept well, if this suffering woman can be eased l.hrough her mental and spiritual, as well as her physical, travail, if this twisted little child can be entirely rectified-then, and then only, can society say Wfhis watch of mine is worthy of the trust I place upon it. Is it not possible, that one of the contributing causes 'to the growing dissatisfac- tion which is current both within and without the profession is this failure to con- sider the individual? Let us grant that there are many other elements which are of importance but for the purpose of this occasion we shall limit our consideration to this alone. One of the reasons Wh the individualis needs have been lost sight of is sur- . . . V . . . D 2 prismg as it may seem, the rapid advance of medical science. It has outstrlpped the Jhiloso h of healin . More fundamental knowleclee of the reaction of biolo- . 1. P Y g . U . . . gic tissue to normal or altered environment has been made available, then it 1S possible for most physicians to grasp. The sciences of Chemistry, of Physics and of lVlathematics have opened up so many vistas of alluring application to medical practice that Doctors have become confused and have sought a way out of their difficulties by following one line of interest-seeking to perfect themselves in it to the exclusion of all else. This sci- entihc specialization has very naturally led many of the profession so far afield from the patient as a Whole, that they find themselves no longer uspecialistsl'-for that implies a general background against which one division of medicine stands out with especial interest-but rather, to use the word coined by our good friend, Dr. John Jennings, they have become partialists.w ' Let us not decry specialization-far from it. The more perverted the normal functions of the body become, the more necessary is the light of scientific special- izedknowledge. Surgical procedures, requiring the utmost nicety of judgment and skill can only be undertaken by one whose experience in such matters is ex- tensive and whose scientific training has fitted him for them. God forbid that we 10 J, 1-2-T:.Jt -W1 fl rr ...H-t.,.,.,5.,...,,.s,,..qg,...s..,.-...c-+s,,...,..,-.,....,,.,, 41, M--5 f,,,,v,,,- i,,..w :ed Z, ,- -.-.,..-.bca -.a-1-s- ' 'il i Y Q----.. , , --.a,. ,-L.,..-.-..-.....,,.., . 9 V Q ,. W ,, - ---t - . A,,m1..-my,.: TW... im. MY -----.N-.---.1-,---- -.-.F , .i -1 ,----,--f----------- -- --- --A J---- --f-'i--H . 5. lf ., 3 Ar . sg. ' it f 4

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f-fr? gf if if 'A . , gym, I . rife. y,,vH'. ,J , 'U 1 f. L?:.1?EEfze if-.?g-'if s-QSEX, me -ores , ,, ' ,crm - -f -V Y-...-- --f - - -- 7 . 91,-rv Q, , 'Y ,Q Y fg, , gym-, Y,.-,.,, ll 3 jf w-JF if 'aprgula l '- .r fat l 'if 'v personality. Attempt should be made to cull out from the vast number of young men and women, who are constantly knocking at the gates of our medical schools, those who show a true calling for the profession -who really are planning to consecrate their lives to it. In the recent past, too many have either drifted into the study of medicine, or have been pushed into it because of some supposed social advantage, or have been allured into it in hopes of personal fame or financial reward. There is need as never before for earnest and devoted and self-efifacing service in the field of medi- cine. For, as Stephen Paget says, Leif a doctor7s life may not be a divine vocation, then no life is a vocation, and nothing is divine. The Faculty of a School of Medicine dedicated to the training of practitioners of the profession differs from that which has as its aim the equally high goal of the furtherance of medical knowledge. It is essential that the great majority of men, charged with the instruction of those who are to carry on, be selected from the ranks of individuals who are engaged in practice. But simply because a man is a successful practitioner, it does not follow that he is qualified to have a posi- tion on a faculty of medicine! He needs to have an inquiring mind, to be a con- stant and a thoughtful student-Who, by his patient example, can 'Ge-du-catew or Ulead out his pupils into the fields of learning. The only instruction really worth- while is the stimulation of the younger man to learn for himself. The direction of progress can be obtained by sighting along the peaks of past achievement in medi- cal advance but the long, weary march has to be undertaken by each individual student. It is highly desirable that at least the head of each major department be a salaried teacher who is thereby freed from hnancial Worry. He should be encouraged to maintain a limited consulting and hospital service, but his educa- tional and administrative duties demand that his mind be kept clear of the worries which beset one whose oliice is overflowing and Whose list of house calls yet unmade is alarming. Finally, the teachers of Gtotalismi' must be men whose hearts and souls are keyed to the mental and spiritual needs of their patients. Let us not suppose that they can all be trained psychiatrists or religious philosophers but they should be aware of and alert to the important part which is played by these recently neglected phases of human living. Such a school should not be clinically top-heavy. It needs what Osler called the leavcn of science, Without which it would never rise above a doughy mass of sentimental mediocrity. From its laboratories there should flow a constant beam of vitalizing and directing light, to save it from chaos and fioundering. Man's body is biologic protoplasm, and the study of its reactions, normal and abnormal, must be kept ever alive. But the purposes of the science laboratories of such a College are not those of a medical research institute, where all effort is bent solely to the solving of scientific riddles, but rather to the illumination of the path immediately facing the student and the practitioner. The directors of these laboratories, and the younger men who wo1'k therein, need ample space and time for the pursuit of their wearying experimentation, for without these they cannot adequately perform their greatest function, namely, teaching. Instruction, rather than investigation, must be their raison dietre. As Zinsser has said, 'gin our own country there have been Osler, Welcll and some others Who have signed many of their important con- 12 , ' '..u ' Y . V ., Y YJ ,V - .1 in , , , , ,-.,Y, ,H 1 1 , . 1. ,,, .Y .Y it .1 .I x -5.2. 7