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

Page 18 text:

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

Page 17 text:

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

Page 19 text:

A, ir ,im ,nr YV A V, f 1 - fillii iirltitlgiii fl 5:11 tributions to the medical sciences With the names of innumerable pupils whose minds were the materials on which they carried out their experiments.'7 Such a College as we have been describing must do all Within its power to formulate an integrated curriculum.. Good organization pre-supposes departmental autonomy-but care and patience must be exercised to break down the inter- departmental barriers-ior after all, each division of teaching is but a part of a grander scheme. Anatomy, for instance, must not be pictured by the students- or the faculty either, for that matter-as a course conducted for a given number of hours in a specific room and, upon its completion, never to be thought of again till ,tis time to study for the State Board examinations. Rather, into the period of its intensive study there should be interjected the physiologist to show its relation to body function, and the clinician to enliven it with his discussion of its applica- tion to the cause and cure of disease. And to the operating room or the bedside, the trained anatomist should be called to shed light onto the problems of diagnosis or therapy. lts laboratory doors should stand ever ajar so that later on the stu- dent can enter for further and leisured study. And what is true for anatomy is of at least equal importance for the other sub-clinical sciences, and of even greater application to the so-called medical specialties. For instance, the opthahnologist should perform the bulk of his undergraduate instruction in the general medical clinic or on the medical Wards Where his trained mind can be of greatest help in the diagnosis or management of systemic diseases which happen to present ocular manifestations. The clinician can reciprocate and the students Who participate in the discussion be benehted by such interchange of opinions. Close co-operation is particularly important between the major clinical divisions and two rapidly developing branches of medical education, namely, preventive medicine and psychiatry. Sickness shall ever be with us but the emphasis of mod- ern medicine is definitely toward that ideal which has long been accredited to the ancient Chinese-prevention of disease. It is essential that this phase of instruc- tion be kept ever before the student. The man trained to think of community health in its broad aspects should have access to the wards and clinics Where his point of view regarding the etiology of disease as exemplified in the hygiene and habits of the individual patient can fortify the opinions of the clinician-in-charge. Field visits to great civic centers where groups of babies are being kept Well, or to in- dustrial centers Where occupational diseases are being held in check, may help to orient the undergraduate to his social obligations. And hnally, regular health ex- aminations of all the students and of faculty as Well should be made as a personal reminder of the importance of the prevention of disease. Normal psychology and the study of the neuroses require a very constant and continuous place in an ideal curriculum. Not only shall they be taught as educa- tional entities, but here again the general Wards and dispensaries should be open to the psychologist and the psychiatrist. To the staff of each of the major clinical departments it is advisable to add a man with this special interest so that the personalities of the physically sick can be studied and strengthened. The amateur in general surgery is a public menace-but no more so than the uninformed physician who meddles with that most intangible and precious asset of man -his 13 Fi . ,Il , Q , Y ., ' ' , f' Yilff' 7 'f Zi T ,fa