During my training in medical school, it wasn’t uncommon on the wards to hear a passing reference to the great William Osler. With his boyish shock of hair and regent moustache, Osler was a Canadian-born physician who trained at McGill and rose to prominence through clinical and professorial appointments at Penn and Johns Hopkins University. With a passion for clinical diagnostics, Osler would breathe life into the art of nuanced history gathering and astute physical examination. His name would become eponymous for various diseases (Osler-Weber-Rendu disease or hereditary hemorrhagic telangiectasia) and clinical findings (Osler nodes of bacterial endocarditis). Osler’s style of bedside rounding would become the staple of modern Western medical education. And his lucid writing, be it clinical (in his bestselling, internationally published textbook, The Principles and Practice of Medicine) or philosophical (in his widely circulated speech, Aequanimitas), offered a warm, guiding light through the thorny wilderness of medicine.
Yes, when I was in medical school, everyone knew William Osler.
But not anymore.
William Osler has been dubbed The Godfather of modern internal medicine. But today, when I begin giving my lecture Why William Osler Matters to medical students and residents, I increasingly encounter blank stares and puzzled looks.
Oh sure, it might be argued: What is the relevance of an old doctor practicing antiquated medicine from over one hundred years ago? For Pete’s sake, these clinicians didn’t even have antibiotics, cardiac stents or chemotherapy! In a modern era of PET/CT scans, microsurgery and emerging gene therapy (so the reasoning goes), shouldn’t William Osler and his ilk easily be lumped with the goofy bird-beaked bubonic plague doctor of centuries ago? What, in an age of technological dynamism and scientific breakthrough, does the quaint William Osler have to teach us?
If technology is the metric and scientific advancement is the bar, then every age seems to humble the last. In his day, Osler dazzled students and colleagues with autopsies showing diseases that even the most seasoned physicians had never seen from the inside. But now, the most green medical student can study the human body with the masterful help of Frank Netter’s Atlas of Human Anatomy or peer at exquisite MRI, CT or bedside ultrasound images of human disease in real-time.
But instead of disparaging his predecessors for their ignorance or haughtily tut-tutting about the cutting edge of practice as he knew it, William Osler revered his medical ancestors. He would encourage (as he was likewise encouraged) to drink deep from the wisdom and experience of the great physicians of the past. Do you want to learn about Hodgkin’s disease? Read what Hodgkin had to say about it. Curious about Bell’s palsy? Why not explore the writings of Bell?. Nowadays, while we shamelessly try to eradicate every eponym in the name of political correctness and pathological puritanism, we are simultaneously erasing the history of medicine one man or woman’s hard-earned discovery at a time. Osler would have none of it. He often quoted Soren Kierkegaard saying, “We live forward; we understand backward.”
Here is something, however, that I have learned about the story of William Osler. With the scientism-rooted mindset that has surrounded the modern telling of Osler’s story, I am not surprised that he is now forgotten. We have created a shell of a man and have nodded smugly when he is easily tipped over. If Osler’s great claim to fame was his ability to percuss a chest or discern a murmur or palpate a pulse, then he deserves to be shelved along with those odd medical gadgets and passably useful elixirs of a bygone age. We have simply moved beyond them…and perhaps, likewise, him.
But that is not who Osler is and why Osler matters.
The William Osler I encountered when I read biographies and speeches and essays was a physician who still has a great deal to teach us. To be sure, Osler was bright and inquisitive, insightful and innovative. But that is not the secret of who he was.
William Osler matters because he was intentional.
In a life of infinite demands, Osler was present to the moment. He was inspired by Thomas Carlyle’s insight, “Our main business is not to see what lies dimly at a distance, but to do what lies clearly at hand.” He determined with the greatest of discipline to not ruminate on the past or obsess about the future, but to be here now. Osler modeled the advice he gave saying, “Think not of the amount to be accomplished, the difficulties to be overcome, or the end to be attained, but set earnestly, at the little task at your elbow, letting that be sufficient for the day.” And so whether he was treating a patient, mentoring a student or speaking with a colleague, he was earnest and genuinely engaged. He had an enormous capacity for friendship.
The anecdotes are legion about William Osler fondly remembering a student from long ago, welcoming him into his house and finding a way to help him in the next stage of his career. When his brilliant, yet troubled, surgical colleague William Halsted would disappear on a drug-infused bender, Osler would take Halsted’s young charge, Harvey Cushing, under his wing. And when Halsted would return, William Osler was the friend he could rely on. Every institution (McGill, Penn, Johns Hopkins) went through a painful rending of garments and gnashing of teeth when Osler moved on to his next assignment. He was that good. He was considered such an asset that his mentor and friend, Dr. Palmer Howard likened time spent with Osler to drinking a potent ferment. And then there was the time, in the dark Baltimore night, when Osler happened across a broken down mother and her sick child in the street. He hailed a carriage, helped the sick girl in and handed her a note. Osler paid the driver and directed him to Johns Hopkins. Upon arrival, the medical staff would unfold the note that they had seen before. This was one of “Mrs. Osler’s youngest”, the note informed, and was to be cared for until Osler arrived to help her himself.
Once upon a time (in many medical schools), a book carrying the collected speeches and essays of William Osler was given to every graduating medical student. And premier among them was the valedictory address he gave to the medical graduates at Penn (1889) called Aequanimitas. In this speech, Osler extolled the virtue of equanimity – an evenness of temper – with which a good physician should practice. It is important to be composed, perhaps even a bit removed, when dealing with the stresses of an acute illness or a poor prognosis. But Osler didn’t leave it there as if the highest virtue of the physician was to have ice in one’s veins. Instead, he described the delicate balance that the true physician must maintain.
Cultivate then…such a judicious measure of obtuseness as will enable you to meet the exigencies of practice with firmness and courage, without, at the same time, hardening ‘the human heart by which we live.’
The art of being a true physician is finding the balance between equanimity and empathy.
The other balancing act William Osler modeled was between intentionality and efficiency. Osler was known for his extraordinarily kept schedule with hours devoted to work and recreation (which always ended with a ten o’clock reading of a non-medical classic). But in the midst of his exquisite time management, Osler was intentional. He was present to the moment. As biographer Michael Bliss would write,
[Osler] had the knack most often found in politicians (though he despised politicians) of giving you all his attention and interest, perhaps taking you by the arm, listening intently, remarking on an encounter years earlier or on some other bond you had in common, convincing you that for William Osler at this moment you are the most important person in the world…and then he moves on.
To be sure, modern physicians needs to be smart. And they need to have a fluency with the scientific literature and medical technology. But, even more, physicians need to be wise and engaged. In the midst of binging on innumerable facts that I was too soon asked to purge for a test, no one in my medical school experience every described the nuanced balance of intentionality and efficiency, of equanimity and empathy in quite the way William Osler did. Medical facts change. Technology evolves. But these wise truths are eternal. And eternally necessary.
True…many medical facts of William Osler’s era are considered wrong and the technology is outdated. But his philosophy is not.
That is the lesson I learned from this greatest of physicians.
Perhaps if we paid as much attention to being present to the patient as we paid to being on time, or to earnestly caring for the patient as we paid to staying objective, we would feel the fire that inspired William Osler. Perhaps, even more than becoming great physicians, we could become great people.
Why does William Osler matter?
Now you know.
Photo credit: Wikimedia Commons