On the shoulders of medicine's giants : what today's clinicians can learn from yesterday's wisdom

251 Pages·2015·1.19 MB·English

by  Taylor

Robert B. Taylor
On the Shoulders of Medicine’s Giants
What Today’s Clinicians Can Learn from Yesterday’s
Wisdom
Robert B. Taylor
Department of Family Medicine, Oregon Health and Sciences University School of
Medicine, Portland, OR, USA
Department of Family and Community Medicine, Eastern Virginia Medical School,
Norfolk, VA, USA
ISBN 978-1-4939-1334-3 e-ISBN 978-1-4939-1335-0
DOI 10.1007/978-1-4939-1335-0
Springer New York Heidelberg Dordrecht London
Library of Congress Control Number: 2014954588
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In the continual remembrance of a glorious past individuals and nations find their
noblest inspiration.
—Sir William Osler (1849–1919)
The leaven of science. Philadelphia: Wister Institute of Anatomy and Biology of the
University of Pennsylvania; 1894, page 79.
Medicine is the oldest learned profession in the world and it is rooted in the past.
Each successive generation of doctors stands, as it were, upon the shoulders of its
predecessors, and the fair perspectives that are now opening before you are largely the
creation of those who have gone before you. It is therefore reasonable to think that
anyone who has spent a long professional life in medicine must have something to pass
on—however small or modest.
—British neurologist Sir F.M.R. Walshe (1888–1973).
In: Canadian Medical Association Journal. 1952;385:67.
You have chosen the most fascinating and dynamic profession there is, a profession
with the highest potential for greatness, since the physician’s daily work is wrapped up
in the subtle web of history. Your labors are linked with those of your colleagues who
preceded you in history, and those who are now working all over the world. It is this
spiritual unity with our colleagues of all periods and all countries that has made
medicine so universal and eternal.
—Spanish-born American physician and educator Felix Martí-Ibáñez (1911–1972).
Epilogue: To be a doctor.
In: A prelude to medical history. New York: MD Publications; 1961, page 197.
Preface
This book, intended to make you a more knowledgeable clinician, presents selected
insights of some of the history’s leading physicians, scientists, and scholars—the
admonitions of Hippocrates, what Edward Jenner had to say about the end of smallpox,
Sir William Osler’s thoughts about uncertainty and probability in medicine, and
Florence Rena Sabin’s vocal commitment to believing in her work—and describes how
their words are pertinent to the current practice of medicine. This book will show how
much the thoughts of medicine’s giants were prescient, and are manifested in what we
believe and do today.
The book’s title is inspired by the words of the English physicist and mathematician
Isaac Newton in 1676: “If I have seen further it is by standing on the shoulders of
giants” [1]. There is, of course, evidence that the metaphor describing standing on
shoulders of predecessors predated Newton in various iterations [2]. Attribution
squabbles notwithstanding, as we ponder this image, an example that comes to mind is
the 1854 prophetic comment attributed to John Snow that the key to elimination of the
great plagues, such as cholera, would lie in understanding how they are propagated.
Today’s knowledge of disease prevention is built upon the findings of Snow and others
like him.
In this world of electronic medical records, virtual physicians, and nocturnalists
(physicians who choose to work the “graveyard” shift in hospitals), why do we need a
book based on the wisdom of our forebears? Perhaps the answer lies in the premise of
the query: We have become deeply enchanted with the twenty-first century’s dazzling
technology, expansive communication options, and lifestyle-oriented practice choices.
And in doing so, we risk losing touch with the passion for clinical excellence and
commitment to service that made medicine what it is today.
There is another reason this book is important. Today’s healers enjoy a level of
societal confidence and trust that is the envy of our colleagues in other professions. In
the 1940s, American author and newspaper columnist Damon Runyon quipped: “My
old man used to say that he guessed the percentage of scoundrels was less among
doctors than any other class of men, professional or otherwise, in the world” [3]. This
lofty status exists only partly because of the good works of we, the living, but is much
more a legacy of the dedication, perseverance, and stature of those who created today’s
house of medicine—the medical giants upon whose shoulders we stand. If only for this
reason, we should all spend some time learning about our heritage.
The topics discussed are diverse. They range from basic science to philosophy, from
doctors to patients and their families, and from classic descriptions of disease to how
clinical caregivers view their world. Some quotations, such as Lewis Thomas’
observation that “most things get better by themselves” are presented with a hint of
irony as we consider the heroic therapy often employed in modern clinical practice.
Other discussions, such as Albert Schweitzer’s commitment to service, are
unashamedly inspirational, and some have a touch of pragmatism, as in William
Heberden’s advice to cease doctoring at the right time, before one can no longer do
justice to patients. Some are reflective, as the thoughts of Elizabeth Blackwell,
America’s first female medical school graduate, about being a pioneer. And I include a
few notions that time has proved to be quite erroneous.
Is this just another book of medical quotations? Not really. The thoughts presented
are, in most cases, whole paragraphs, allowing greater elucidation of the authors’ ideas
than is possible with a single adage. One example is the paragraph taken from the 1927
article The Care of the Patient , by Francis W. Peabody, although, as you will see in
Chap. 3 , I might have quoted only the memorable last sentence. In the case of
Elizabeth Kübler-Ross M.D., the selection is both extended and metaphorically vivid.
Robert Lewis Stevenson’s representation of physicians as standing “above the common
herd” cannot be summarized in a few words. On the other hand, pithy quotes such as
the observation by Sir Dominic Corrigan that “The trouble with doctors is not that they
don’t know enough, but that they don’t see enough” might reasonably be termed
aphorisms. There are even a few poems included in the book.
Are all quotations from the past? Not by any means. In searching for sayings that
resonated with my idea of what medicine should be, the characteristics of the ideal
physician, and the broad panorama of medical practice in history and today, I came
across a number of thoughtful insights penned by “modern” physicians, scientists, and
other writers. And while some may hold that these persons have not yet been accorded
the status of “giant,” I felt that their words merited inclusion in the book. Thus, in
addition to Celsus, Hunter, and Pasteur, I have included the writings of some
individuals, such as Edmund Pellegrino and Barbara Starfield, who have shared our
time on this earth, and others, including Abraham Verghese and David Hilfiker, who are
still contributing to medicine.
In assembling my sources, I was forced to make some decisions. First of all, should
I return to the same source more than once? In fact, I could easily have presented an
Oslerism on every third page. I decided that, for the sake of variety, I would cite major
extracts from the works of Galen, Freud, Sydenham, and other familiar names only
once in a chapter, and that I would lean toward including a broad range of “giants.”
Hippocrates, Virchow, Osler, and a few others do, however, show up more than once in
the book.
I also faced the question: Who is medical giant? It is someone, and not necessarily a
physician, whose thoughts, words, and deeds have helped make medicine what it is
today. I concluded that some writings by nonmedical authors such as Aristotle, Rudyard
Kipling, and Michael de Montaigne have influenced how we view medicine and
physicians, and hence their words are included.
A few giants have given us a treasury of medical quotes, sometimes including a
notable “signature” adage. In these instances, I have given preference to the well-known
saying, even though some writings that are less well known are also perceptive. For
example, the words “Chance only favors the prepared mind” will always be linked to
Louis Pasteur.
A more vexing issue was this: What about publications with multiple authors? I
have found some astute thoughts in committee-authored articles, some with as many as
five or six contributors. I decided that these words had been polished by many hands
and also, I suspect, were subsequently buffed by unnamed editorial assistants. Thus I
could not describe the entire team of authors as “giants,” although some multiauthor
publications are cited in my annotated comments.
For the most part, this book is grounded in literature, not simply the product of my
personal reflections (although there are more than a few of the latter), and source-based
annotations are supported by reference citations. Most are from the mainstream medical
literature—published books, historical documents, peer-reviewed journals such as The
New England Journal of Medicine , and so forth. And, in an effort to make the content
timely and relevant, I have also used some less traditional resources such as the Wall
Street Journal , the New York Times , and the World Wide Web .
This book may never lead you to a “eureka” diagnosis or guide a brilliant
therapeutic drug choice. I hope that it will, however, influence how you think about
your profession, your patients, and your career, and help you avoid the fate of becoming
an “automated medical kiosk” [4]. I will be delighted if this book helps rekindle your
idealism regarding what medicine is at its core, and that it reminds you how being a
physician can be what Osler termed “a daily joy” [5].
On the Shoulders of Medicine’s Giants is intended not as a text or reference source,
but as an enrichment book . It is, fundamentally, a collection of perceptive quotations,
with comments. Perhaps you will experience an “Aha” moment of recognizing the
historical origins of why we think this or do that. I hope that you will find it fun to read
—perhaps on a quiet evening or while passing the time on a long plane ride—and that
your life will be a little richer for it.
1. Turnbull HW, Ed. The correspondence of Isaac Newton, vol 1. London: Cambridge
University Press; 1959; page 416.

2. Dorizzi RM. Standing on the shoulders of giants—Isaac Newton? Bernard of
Chartres? Priscian! (letter). Pharos. Alpha Omega Alpha Honor Med Soc. 2012;75:1.

3. Runyon D. From the author’s long-running newspaper column: “The Brighter Side.”
c.1943. Available at: http://n ostrums. blogspot.c om/2 010_ 03_ 01_a rchive.h tml .

4. Bynum W. Why physicians need to be more than automated medical kiosks. Acad
Med. 2014;89:212.

5. Osler W. Aequanimitas, ed 3. Philadelphia: Blakiston; 1932, page 423.

Robert B. Taylor
Portland, OR, USA Norfolk, VA, USA
Contents
1 The Profession and Professionalism
Science, Art, and the Profession of Medicine
Professionalism and Personal Gain
A Physician’s Vow
The Joy of Medicine
The Privilege and Power of the Physician
The Essential Unit of Medical Practice
Medicine as a Social Science
From Aesculapius to Evidence-Based Medicine
Power and the Dream of Reason
Professionalism and Compassion
Professionalism, Quality, and Social Benefits
The Physician’s Duty and Continuity of Care
2 Being a Physician
Protecting the Patient
Courage in Times of Crisis
About the Health of the Physician
Ceasing Doctoring at the Right Time
The Self-Complacency of the Young Physician
The Physician as Advocate
Being a Pioneer
Standing Above the Common Herd
Hobby-horses, Tyrants, and Mighty Purposes