The Green Years of Medicine, 1971
Page  1

the greek years of medicine martin x cummings m.d rev henle dr mcnulty dean rose members of the faculty and staff honored graduates guests and friends a great physician once said ztork and system gradually train a man's capacity go read intelligently and periodically but only while the green years are on his head is the habit to be required as in a desultory life without fixed hours and with his time nt the book aaa ea of everybody a man needs a good deal of reserve and determination to rnvkvca1 it 1 sir william osier wrote this in 1909 in discussing the role of the io library in post-graduate education he was of course exhorting student of medicine and young physicians to acquire the habit of reading and study he age when it serves as the beginning of sustained continued education for those like myself who are in their gray or balding years such advice comes too atol today medical schools are challenged to change curricula the federal government is straining to find new ways to support medical education the profession itself is seeking methods of re-examination of its members to their competence to practice in my view none of these actions to improve medical care is as important as disciplined continuing self education jug h is this set in motion and sustained a great part of post-graduate reading must take place in a man's the physician has little time during his practice for such study i;;uoh o n post-graduate education will come from exposure to his patients and commencement address georgetown university school of medicine may if director national library of medicine osler wm , the medical library in post-graduate work

Page  2 in the clinic or community hospital the rest will come from participation meetings conferences and other scheduled events all of these activities to information seeking for continued education all must be pursued but preferably as a matter of pride ana satisfaction in their search for social relevance many students are seeking adequate environments for post-graduate experience although this may prove to be satisfying on a temporary basis i do not believe it will load og bettor health care in the long run the same general public which new complain about the rising costs of health care will protest even more vehemently discover that the quality of health care has deteriorated because of c or less comprehensive medical education even if the public docs nor di:.;cuwj our inadequacies a new flexner will emerge to do so training physicians for tomorrow's health care delivery systems capitalize upon existing medical school programs of excellence leather dismember the scientific base which has been built over the past two should find new ways to re-introduce the art of medicine in all of dimensions as a complimentary rather than competitive element the same philosophy applies to medical practice young physician be discouraged from practicing scientific medicine rather they should to place the patient at the apex of our efforts to heal of using edge new technical applications and human understanding in a roasonua a mix if we sacrifice the first two ingredients for exclusive emphasis on a third we may keep patients happy but not solve their basic medical 2 flexner in 1925 pointed out the relationship between the science u r of medicine when he wrote thus medicine moving as rapidly as may be 2 f exner a medical education a comparative study the macmillan co a y 1925 p 7

Page  3 scientific status recognizes no difference in intellectual attitude between laboratory and clinic neither can--nor should--any distinction in tol otual attitude be drawn between investigator and practitioner for centuries question was not even raised from hippocrates down those who contribute their successive bits of precious knowledge to the growing structure were practitioner using their keen wits at the bedside the more systematic and self-ec promoters of scientific medicine in modern times did not for a moment that the spirit of scientific inquiry belonged to them as while as physicians or teachers a merely practical empirical or technological was appropriate i will admit that in more recent years some scientists have tender grade the importance of clinical observation and bedside teaching where ti,.e red problems of medicine are ultimately solved however informed administration now recognize that a balanced relationship among research education american is required for progress in health and medicine one cannot flourisn v iine t support of the others if one dominates the others all three elements may be degraded there is much discussion that the rapid emergence of medical res arc in this country may have suppressed the health educational and service somewhat even if this were true it could be more damaging to swing to in the other direction we need to narrow the use of empiricism while the application of science for empiricism may lead to quackery while mio loads to truth 3 oliver wendell holmes in an address delivered to trie graduating ca at bellevue hospital college in 1871 said science is a great traveler am wears holmes oliver w medical essays 1862-1682 houghton mifficn ani co cambridge mass 89

Page  4 her shoes out pretty fast as might be expected he went on to point out that " all systematic knowledge involves much that is not practical yet it is the only kind of knowledge which satisfies the inirid and systemic study proves in the long run the easiest way of acquiring and retaining facts which are practical medical schools throughout the nation are seeking new approachs to medical education with regard to curricular changes i as told that georgetown along has introduced clinical training during the first year of undergraduate medical education and that the fourth year is now free for student electives i have no quarrel with this approach so long as we avoid a return to pre trade school medicine the key to success of such a program depends on the wise selection of electives the faculty should particpate actively in the selection process this elective year should be free from the necessity to memorize much of which will change rapidly and instead the time should he used to learn how and where to find information when it is needed some of the medical knowledge which you learned last year will be obsolete before you can apply it next year encouraging students to become familiar with the library during elective can be a rewarding use of this time now that this medical school has a special new library it seems to me essential that the faculty encourage students to importantly also plans should be made to allow your librarians to demonstrate how to share efficiently the collected store of information with students faculty and health practitioners if they teach little more than how to use dr john billings index catalog his index medicus and its successors you will have a powerful tool for information retrieval some departments have pioneered in the development of audiovisual teaching units dr proctor harvey of your department of medicine has been particularly

Page  5 ingenious in developing teaching materials for cardiology v/'nen they rc made available widely as learning resources which can be ust'd r,o easily as books and journals then the real utility of these materials for cw u i ,\: education will become apparent i have learned that students and y ..; ir are more willing to use such new modalities to gain information than tho p generations which had less exposure to television computers and otnor v communications devices . i do not mean to suggest that these new technologies will replace boo books still represent a most compact convenient and durable form of inform storage a well indexed book can be used efficiently for information ::\ .:.,,:.; without fear of electrical or mechanical failure one only needs a book to pick up the program sequence at any convenient point in time it oa b in the bedroom as well as the classroom it is a democratic source of hwo since it may be borrowed as well as owned just as man does not live by bread alona neither will his education l nourished by books alone osier recognized this when he wrote whi ; his medical education and making his calling and election sure isy narn v."r young doctor should look about early for an avocation a pastime that wl toko him away from patients pills and potions in a society beset by poverty prejudice and war time see asluo fw amusement and recreation provides essential guardians of pnysicv;.l anu :..,..,,_,, iicalth the young physician in the spring of his career can more eas::..i.y :.; such choices and commitments than the tired oa_d work horse wno jenovj on.:.y ' route from his home to his office clinic or hospital and then back nome osier wm , the medical library in post-graduate work lrit i-'ed ."/., 2 '/.-:'.'-

Page  6 one such avocation which attracts too few physicians in this century is tjie study of the history of medicine so profession has a heritage richer tha ours therefore it is full of good ore to be mined oy young and old ai'ike hi only does historical study enrich the mind broadly it sometimes icud to i\x of information which may have practical contemporary value tubocurarine a drug used in anesthesia is derived from the ancient ij.d.i poison curare quinine used in the treatment of malaria was derived from a much drug cinchona bark nauwolfia a recent discovery in india was derived from the havv/olf 1 , corpont ina a plant used in the traditional medicine of india in each case a knowledge of the historical use of the drug placed an ess role in its adaptation for modern use because of this the chinese today are investigating intensively the therapeutic value of their traditional medicines in trie j.ignt of vi,ge.em p a r..'a above all historical studies and historical knowledge add perspective ;.,.,. understanding not only to scientific problems and questions in medical p/rao e and research but to the many ethical social and economic problems fael.,,g tj . liodical profession today and more importantly facing our citizens au g'si in considering questions of social policy i think all of us here wouii av it is important for the citizens of this democracy to know about k,s history " the traditions that have made it great i believe physicians should have the same respect for their history and traditions and that tney will be oette , if they do unfortunately education in the history of medicine is sadly lacicng n .., than half of our nation's medical schools concerned by this deficiency

Page  7 y john bowers president of the macy foundation quoted from a let;,ar fro.;i a nobel laureate as follows history is the study of recorded knowledge j.1 ,.-... library is the repository of this knowledge the two should wwrk kog history extends from the present movement all the way baek as fa as roe all this is self evident but neither students nor faculty now hava the c.c;..c history as pervading all thought both retrospective and prospective a vas amount of present day research simply represents work already done am l a -..,:.] faculty and students should be more alert and aorc learned " oliver wendell holmes said it even more succinctly the knowiud u ;.' v.aa finds a soil in the forgotten facts of yesterday lie went on to point i a 1 youth had many advantages as they enter the practice of medicine t.in y\.i ,..,.; trail's senses are quicker than those of his older rival ' his education '. ,\ a j the accessory branches is more recent and therefore nearer the oxistiag c j of knowledge his most powerful statement in support of youth is simply v i\ow ideas build their nests in young men's brains granting all these advantages to today's graduates in their gr^e yoa should remember that tliey must continue to study for the rest of tnair .; i u.im the health professional mustmacy foundation quoted from a let;,ar fro.;i a nobel laureate as follows history is the study of recorded knowledge j.1 ,.-... library is the repository of this knowledge the two should wwrk kog history extends from the present movement all the way baek as fa as roe all this is self evident but neither students nor faculty now hava the c.c;..c history as pervading all thought both retrospective and prospective a vas amount of present day research simply represents work already done am l a -..,:.] faculty and students should be more alert and aorc learned " oliver wendell holmes said it even more succinctly the knowiud u ;.' v.aa finds a soil in the forgotten facts of yesterday lie went on to point i a 1 youth had many advantages as they enter the practice of medicine t.in y\.i ,..,.; trail's senses are quicker than those of his older rival ' his education '. ,\ a j the accessory branches is more recent and therefore nearer the oxistiag c j of knowledge his most powerful statement in support of youth is simply v i\ow ideas build their nests in young men's brains granting all these advantages to today's graduates in their gr^e yoa should remember that tliey must continue to study for the rest of tnair .; i u.im the health professional must realize early that much of today's macy foundation quoted from a let;,ar fro.;i a nobel laureate as follows history is the study of recorded knowledge j.1 ,.-... library is the repository of this knowledge the two should wwrk kog history extends from the present movement all the way baek as fa as roe all this is self evident but neither students nor faculty now hava the c.c;..c history as pervading all thought both retrospective and prospective a vas amount of present day research simply represents work already done am l a -..,:.] faculty and students should be more alert and aorc learned " oliver wendell holmes said it even more succinctly the knowiud u ;.' v.aa finds a soil in the forgotten facts of yesterday lie went on to point i a 1 youth had many advantages as they enter the practice of medicine t.in y\.i ,..,.; trail's senses are quicker than those of his older rival ' his education '. ,\ a j the accessory branches is more recent and therefore nearer the oxistiag c j of knowledge his most powerful statement in support of youth is simply v i\ow ideas build their nests in young men's brains granting all these advantages to today's graduates in their gr^e yoa should remember that tliey must continue to study for the rest of tnair .; i u.im the health professional must realize early that much of today's accopoaa p/..lir':".j . may be tomorrow's malpractice ultimately we are each judged not on...y .::'..;..' .....' l-;now but also for how we use our knowledge finally i end this imperfect and incomplete essay with the nope t,.,a ,;, e will be some among you who like members of this faculty wij.1 ijeco;,-,a i.no'..1 :.. ;-, and skilled in teaching research and practice for only those vno partac.-pat in all of these activities can know the real joys and satisfactions whien cov..e "" blake john b education in the history of medicine mocy founaauion - hat ion library of medicine conference hefner publishing co k.y iyoo p {.

Page  8 from generating new knowledge sharing it with others and applying it to help your sick and disabled fellow citizens much of what i have snid has been offered to students as advice ov oji:.u:;j by wiser and more experienced persons but only a few have the privij.ugi v,o express these views on the occasion when the youth of medicine aru for a '...;/ recognized and honored at their commencement . i shall not abuse this privi.l further congratulations and best wishes for a successful career in medicine our groubied society will be enriched oy your talents and efforts