Transcript UNIVERSITY OF VANDERBILT SCHOOL OF MEDICINE

UNIVERSITY OF VANDERBILT
SCHOOL OF MEDICINE
A PHILOSOPHY OF MEDICINE : LESSONS WE AND
OUR PATIENTS HAVE RECEIVED WITH GRATITUDE
H. Cecil Coghlan, MD,FACC. Professor of Medicine
University of Alabama at Birmingham
Medical
History
First Edition of
Principles of
Internal Medicine
1951
T. R. Harrison
Paul B. Beeson
William H. Resnick
George W. Thorn
M. M. Wintrobe
Introduction
Approach to the Patient
► No
greater opportunity, responsibility, or obligation
can fall to the lot of a human being than to
become a physician. In the care of the suffering
he needs technical skill, scientific knowledge, and
human understanding. He who uses these with
courage, with humility, and with wisdom will
provide a unique service for his fellow man, and
build an enduring edifice of character within
himself. The physician should ask of his destiny no
more than this; he should be content with no less.
T. R. Harrison, Principles of Internal Medicine, 1951
APPROACH TO THE PATIENT
► In
the practice of medicine the physician
employs a discipline which seeks to utilize
scientific methods and principles in the
solution of its problems, but it is one which,
in the end, remains an art, in the sense that
rarely, if ever, is it possible to exclude
judgment and experience from the
interpretation of the patient’s reactions.
T. R. Harrison, Principles of Internal
Medicine
Words of Wisdom
from “ The Chief “
RE- SEARCH : “ cooking the scraps of other’s fare “
Versus
PRE- SEARCH : “
blazing new trails for the human
mind”
T. R. Harrison, 1974
Left Ventricular Function.
O. Frank., Z. Biol., 1895; 32: 370
Response of the frog
ventricle
To increased filling
pressure
Professor
Tinsley
Randolph
Harrison
1900-1978
PHILOSOPHY OF EDUCATION
EDUCATIONAL EQUATIONS
TINSLEY R. HARRISON , M.D.
►“
Such modest abilities as I may have as a
teacher are the consequence of an
educational philosophy arrived at by the
fortunate combination in William Osler of a
clear head and a warm heart. The training
of a pupil may be compared to the rearing
of a child. The best assurance that a teacher
has of achieving his objective is to attempt
to be the kind of person he wishes his pupil
to become “
EDUCATIONAL PHILOSOPHY
Tinsley R. Harrison
►
The training of a physician is both similar to and different
from the training of an engineer. For both, the precise
thinking derived from quantitative measurements and from
scientific principles is essential. But because the physician
does not deal with inert raw materials and only secondarily
with machines but rather with people, impaired by disease,
afflicted by suffering, and hampered by fear, even the
finest and clearest scientific thinking is not enough. Like
the minister, the priest or the rabbi, the physician needs a
deep and pervading humanity. It does not seem an
insuperable task for our medical schools to train physicians
that can think like engineers and feel like ministers
Educational equations inspired by
Albert Einstein
 E = h H2
 E= education, h = teacher’s head, H = teacher’s HEART
 E = mc2
 E = education, m = mental interaction between teacher
and pupil, c = mutual, partial cardiac transplantation.
 “ If a teacher leaves behind him pupils and pupil’s pupils
whose hearts are warm, whose minds are fertile and
whose goals are high, he has not lived in vain”
“Support “
►
“ Never forget that we physicians can cure sometimes, but
must comfort always “ ( T. R. Harrison )
►
The patient said softly: “ My doctor’s love is as important
to me as his chemotherapy “. For a long time, I had carried
the belief that, as a physician, my love didn’t matter and
the only thing of value I had to offer was my knowledge
and skill. I now realized that medicine is as close to love as
it is to science, and its relationships matter even at the
edge of life itself. ( R. N. Remen, Kitchen Table Wisdom ,
1996 )
A Spanish Proverb
►Make
sure you never forget that the
“ devil “ knows so much, not because he
is a devil, but because he has been
around for so long.
Albert Einstein
in his study
in Princeton
1939
“ The
important
thing is to
never stop
asking
questions “
THE PRACTICE OF MEDICINE
T. R. Harrison, Principles of Internal Medicine
►Tact,
sympathy and understanding are
expected of the physician, for the
patient is no mere collection of
symptoms, signs, disordered functions,
damaged organs, and disturbed
emotions. He is human, fearful, and
hopeful, seeking relief, help and
reassurance.
THE PRACTICE OF MEDICINE: PHILOSOPHY UPDATE
2006
►
Patients serve as a unique scientific resource. They report
what is wrong, we have to make sense of what they teach.
They tell us the truth; we have to avoid dismissiveness as
a defense of our own ignorance. They seek our help; we
have to commiserate with their unintended, unwanted
metamorphosis from independent, private, integrated
personhood to dependent, exposed, disintegrated
patienthood.
David S. Goldstein, M.D., Ph. D., Adrenaline and the Inner World. An introduction
to Scientific Integrative Medicine. The Johns Hopkins University Press, 2006.