The One to Blame

Describing the path of medical training (or most schedules of work in American society) the notion of working 90 hours a week (benevolently reduced from the previously typical 120 hours) or showing up to work 6 am Monday morning and leaving at 2 pm on Tuesday morning, and all the while handling several sharp objects, toxic medications, and various tubes jammed into the actual veins and bowels of very ill fellow human beings--well its all sort of odd. Doctors in training are of course made of the very same veins and bowels, and have those same pesky requirements of other mammals, namely sleep, food, and the occasion to stop standing. In the medical profession such inconveniences are consoled by profusely attending/manipulating those other* needs of social mammals: acceptance, hierarchy, self importance and a good boy! pat on the head.

It all seemed very strange and i like most sensible people (including Congress) was skeptical of this tradition. [j/k neither I nor Congress nor most people are very sensible at all, but it is no less a reasonable stance]. I was then very shocked to realize the origin of this barbaric method of training that seemed oblivious to the triumphs of industrial society and the invention of the weekend, was invented by no other than my long hero, the pathologist and great teacher, Dr. William Osler.

"Perhaps Osler's greatest contribution to medicine was to insist that students learned from seeing and talking to patients and the establishment of the medical residency. This latter idea spread across the English-speaking world and remains in place today in most teaching hospitals. Through this system, doctors in training make up much of a hospital's medical staff. The success of his residency system depended, in large part, on its pyramidal structure with many interns, fewer assistant residents and a single chief resident, who originally occupied that position for years. While at Hopkins Osler established the full-time, sleep-in residency system whereby staff physicians lived in the Administration Building of the Hospital. As established, the residency was open-ended, and long tenure was the rule. Doctors spent as long as seven or eight years as residents, during which time they led a restricted, almost monastic life.

He liked to say, "He who studies medicine without books sails an uncharted sea, but he who studies medicine without patients does not go to sea at all." He is also remembered for saying, "If you listen carefully to the patient they will tell you the diagnosis" which emphasises the importance of taking a good history.

The contribution to medical education of which he was proudest was his idea of clinical clerkship — having third- and fourth-year students work with patients on the wards. He pioneered the practice of bedside teaching making rounds with a handful of students, demonstrating what one student referred to as his method of "incomparably thorough physical examination." Soon after arriving in Baltimore Osler insisted that his medical students attend at bedside early in their training: by their third year they were taking patient histories, performing physicals and doing lab tests examining secretions, blood and excreta.

He diminished the role of didactic lectures and once said he hoped his tombstone would say only, "He brought medical students into the wards for bedside teaching." He also said, "I desire no other epitaph … than the statement that I taught medical students in the wards, as I regard this as by far the most useful and important work I have been called upon to do." Osler fundamentally changed medical teaching in the United States, and his influence spread to medical schools across the globe."