“To err is human.”
—Alexander Pope (1688–1744)
The Wisest Minds in Medicine
At some point during our careers, we have the privilege of meeting a physician so talented that everyone else pales in comparison. These are those gifted clinicians whose astonishing mastery of medicine makes everyone in their midst feel like inept, babbling fools. They carefully parse the details of case presentations seeking those critical clues that others may have overlooked. Their thinking is in perpetual motion, identifying the pertinent issues and carefully constructing reasoned arguments that support their diagnoses. On a moment’s notice, they can highlight the distinctions between sarcoidosis and Blau’s syndrome or provide a meticulous dissertation on the histopathology of Libman-Sacks endocarditis.
Their physical examination skills are exceptional, too. Surrounded by a bevy of eager learners gathered around the patient’s bedside, they can demonstrate how to palpate a congested spleen’s tip and in a majestic tour de force confirm the anticipated dullness to percussion over Traube’s space, that elusive, crescent-shaped patch of abdominal wall that can shield the enlarged spleen from discovery.
As a trainee, I found it a treat to observe these mentors in their glory, splendidly steering the audience through a complicated case presentation, culminating in a magnificent discussion of its causation and its management.
These teaching vignettes were among the major reasons why many of us chose medicine.
Some of these luminaries have been recognized around the world, perhaps none achieving the status of the inimitable Sir William Osler. There have been others, including Osler’s biographer, the noted neurosurgeon, Harvey Cushing, MD, and the grand masters of internal medicine, Paul Beeson, MD, and Russell Cecil, MD, whose efforts in creating vibrant textbooks shaped the teaching of medicine for generations of students. Of course, there were the notable clinicians residing in every medical community who could always be relied on to provide sage advice to their colleagues.
The constant pressure of having to efficiently diagnose & manage four to five patients every hour makes one look back with envy at the slow-paced, genteel approach of the past.
During those halcyon days of medicine, the pace was slower, the hospital length of stay was longer, the clinic schedules were lighter, and the interruptions in our daily routines were fewer. We had time to think, to carefully chew on the facts of a case. Slow cooking. We spent time in our local medical libraries, where we carefully perused leather-bound volumes in search of papers that enlightened our understanding of an illness. We would even call a halt to all clinical activities so we could attend grand rounds or journal club.