Table Of ContentMedicine
PRESERVING THE PASSION
IN THE 21ST CENTURY
Also by Lois DeBakey, Ph.D.
The Scientific Journal:
Editorial Policies and Practices
Medicine
PRESERVING THE PASSION
IN THE 21ST CENTURY
SECOND EDITION
Phil R. Manning, M.D.
Professor of Medicine Emeritus
Paul Ingalls Hoagland-Hastings Foundation Professor of Continuing Medical Education
Former Associate Vice President for Health Affairs
Former Associate Dean for Postgraduate Affairs
Keck School of Medicine of the University of Southern California
Los Angeles, California
Lois DeBakey, Ph.D.
Professor of Scientific Communication
Baylor College of Medicine
Houston, Texas
PHIL R. MANNING, M.D. LOIS DEBAKEY, PH.D.
Keck School of Medicine Professor of Scientific Communication
University of Southern California Baylor College of Medicine
1975 Zonal Avenue One Baylor Plaza
Los Angeles, CA 90033 Houston, Texas 77030
USA USA
. . .
LIBRARY OF CONGRESS CATALOGING-IN-PUBLICATION DATA
Manning, Phil R., 1921–
Medicine: preserving the passion in the 21st century / Phil R. Manning, Lois DeBakey.—
2nd ed.
p. ; cm.
Rev. ed. of: Medicine: preserving the passion. c1987.
Includes bibliographical references and index.
ISBN 0-387-0046-2 (h/c : alk. paper) ISBN 0-387-00427-0 (s/c : alk. paper)
1. Medicine—Study and teaching (Continuing education) I. DeBakey, Lois.
II. Manning, Phil R., 1921—Medicine: preserving the passion. III. Title.
[DNLM: 1. Education, Medical, Continuing—trends. W 20 M284m 2003]
R845.M36 2003
610'.71'5—dc21 2003042484
PRINTED ON ACID-FREE PAPER.
ISBN 0-387-00426-2 (hardcover)
ISBN 0-387-00427-0 (softcover)
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Dedicated to
practicing physicians,
who have invested many years
in medical school and graduate training,
often at great personal and financial sacrifice,
and who place the highest priority
on the health and welfare
of their patients.
The outstanding advances in information
technology are simplifying and encour-
aging independent, practice-related study,
making it easier for physicians to enhance
learning in the practice environment.
Phil R. Manning, M.D.
An inquiring, analytical mind; an un-
quenchable thirst for new knowledge; and a
heartfelt compassion for the ailing—these
are prominent traits among the committed
clinicians who have preserved the passion
for medicine, even with the advent of
“managed” care.
Lois DeBakey, Ph.D.
The education of the doctor which goes on after
he has his degree is, after all,
the most important part of his education.
JOHN SHAW BILLINGS
Boston Med Surg J. 1894; 131:140.
. . .
The art of medicine cannot be inherited,
nor can it be copied from books ....
PARACELSUS
Foreword,Das zweite Buch der
Grossen Wundarznei,1536 (verso
of leaf b, ed. 1562)
. . .
[T]he student begins with the patient,
continues with the patient,
and ends his studies with the patient,
using books and lectures as tools,
as means to an end.
WILLIAM OSLER
Aequanimitas, with Other Addresses,
“The Hospital as a College,” 1903
Foreword
. . .
The Association of American Medical Colleges recently recom-
mended that the traditional model for lifelong learning, which fo-
cused on attendance at courses, should be replaced by individualized
study closely related to personal medical practice. Phil R. Manning
has dedicated almost all of his professional life to demonstrating that
continual medical education should occur precisely in this fashion.
Lois DeBakey has devoted much of her professional life to instructing
physicians and biomedical researchers in critical reasoning and its
companion, clarity of thought, writing, and speech. Together, they
have created a highly readable book that shows physicians how to
gain the most from their clinical experience and, in doing so, preserve
their passion for clinical practice and lifelong education.
The authors describe techniques used by highly successful clini-
cians and academicians to achieve these goals, synthesizing lessons
from their clinical experience with reading of medical publications
ix
MEDICINE: PRESERVING THE PASSION IN THE 21ST CENTURY
and discussions of clinical problems with colleagues. Personal essays
and reflections by distinguished physicians are woven into the text.
The book’s emphasis is on immersion in practice, with tips on how to
live with this commitment.
Chapters discuss the remarkable advances in information technol-
ogy and medical library services that facilitate the active approach to
learning. In fact, Manning insists that “With the current information
services, there is no excuse for a physician not to remain current.”
On the other hand, the traditional mental model of “information re-
trieval” as equivalent to “staying current” runs aground fairly quickly
when the current medical advances outpace the doctor’s education and
understanding. Few practitioners today attended medical school lec-
tures on introns, exons, transposons, or epigenetics (to name just a few
of the bewildering concepts in the most recent medical journals). Con-
sequently, the highly fragmented research papers that reach us so
quickly via computer searches must fail to educate us if we have not—
somehow, somewhere—gotten a satisfactory understanding of the sci-
entific theories and assumptions that underlie the “current” progress.
This is difficult. Manning and DeBakey include an emphasis on a
physician’s continuing need to be part of the profession, part of a net-
work of colleagues. The computer can, indeed, retrieve facts with great
facility. Yet for us to advance our understanding of difficult areas
needs the interplay of minds. Here, too, this update of the popular first
edition of Medicine: Preserving the Passion in the 21st Century gives
the reader a good start in getting both understanding and facts.
DONALD A. B. LINDBERG, M.D.
Director
National Library of Medicine
x
Preface
. . .
Since the first edition of Medicine: Preserving the Passionwas pub-
lished in 1987, the practice of medicine has changed notably and
so, therefore, has the physician’s approach to lifelong learning. The
spread of managed care has discouraged many physicians for several
reasons: (1) they must often obtain approval from healthcare organiza-
tions for certain procedures, (2) because employers often shop for
more economical health plans, patients may be required to change
physicians, (3) paperwork has increased, and (4) physicians must see
more patients to maintain their income. On a more positive note,
healthcare organizations routinely collect data on individual prac-
tices for financial reasons, and these data can be used to identify ed-
ucational needs of practitioners.
Unprecedented educational opportunities on the Internet are rev-
olutionizing physicians’ access to information, both reliable and unre-
liable. Although the rapid growth of electronic services precludes
xi
