Today, I’m thankful for those who teach us what they know.
Learning a new role or profession takes time. Skilled practitioners, such as carpenters, plumbers, & electricians, learn their trades over several years through apprenticeships, wherein they partner with & are trained by experienced colleagues. This practice of gaining competency and expertise ‘from those in the know’ stems from the Middle Ages, at a time when apprenticeships were coordinated in small villages & towns by craft guilds. But, in reality, the practice started long before then. In ancient Greece, young students would apprentice themselves with the great philosophers of their time in an effort to seek wisdom. At that time, similar traditions held true in the Middle East, China, India, Japan, and other parts of the world.
Our maturation as a species over time has been predicated on the notion that we should seek wisdom and guidance from those with greater knowledge, sagacity, and insight. A child born today finds itself in a very different position than one that might have been born a century ago, let alone several millennia ago. Our knowledge of the natural sciences, mathematics, philosophy, and the arts is passed down from one generation to the next, so that those that follow us are better equipped than our ancestors ever were.
Let’s think about this concept in the context of the advent of the COVID-19 pandemic, caused by the novel coronavirus, SARS-CoV-2. Essentially, on this day (Dec 29) exactly one year ago, several physicians in the Chinese city of Wuhan began recognizing a spate of pneumonia-like cases, affiliated with a severe acute respiratory syndrome (SARS). Since that time, the virus has rapidly been transmitted from person-to-person around the world, inflicting millions of humans and resulting in considerable morbidity and mortality to the human species. Yet, as the virus has frighteningly spread across the globe (now into 188 countries including Antarctica), our scientific knowledge of the viral biology, clinical disease, risk factors, and treatment options has also spread at lightning speed. In hospitals, physicians, nurses, and other healthcare providers have rapidly accrued this sum of accumulating knowledge, and, in turn, treatment outcomes for COVID-19 infection have drastically improved. Vaccines have also miraculously materialized. The wisdom gleaned from these experiences is passed along from one clinician to another, at a speed commensurate to (or even faster than) the spread of the virus itself.
Yet, none of this would have been possible without the foresight and sapience of a Canadian physician named William Osler. Born in Ontario, Canada, in 1849 to a pastor and his devout wife, William initially acquiesced to his parents’ wishes to study to become a minister of the Church of England, thereby following in the footsteps of his father. However, while studying religion at Trinity College in Toronto, William became enamored by medical science. Several of his mentors, including the Reverend William Arthur Johnson, encouraged him to follow his heart and his true passion.
So, after matriculating from Trinity College, William Osler decided to pursue a career in medicine, first at the Toronto School of Medicine and then at McGill University in Montreal. At that time, medical training in North America was in its nascent stages, so William travelled to Europe, including Oxford, Berlin, and Vienna, where he apprenticed with some of the leading clinicians in the world, including the venerable Rudolph Virchow. While overseas, William became familiar with the then-burgeoning practice of “Innere Krankheiten”, or “internal disease.” Unlike the then, well-established practices of surgery and skin-related “external diseases”, this new discipline focused on conditions not seen by the naked eye and within the body itself. This new discipline mandated a cogent understanding of basic sciences (including human physiology, pathology, and the emerging field of microbiology) and a fuller comprehension of the patient’s condition. No longer was medicine just the practice of understanding the external manifestations of the disease. In turn, the field of ‘internal medicine’ was born.
William Osler returned to Canada in 1874, where, in essence, he became the first ‘internist.’ After a decade at McGill University, where he became one of only two Fellows of the British Royal College of Physicians, William was recruited to join the faculty at the University of Pennsylvania. A few years later, he was asked to join three other faculty members as the Physician-in-Chief at the newest hospital in Baltimore, the Johns Hopkins Hospital. William was instrumental in opening the medical school at Johns Hopkins, where he became its master clinician, educator, and diagnostician. At this newly minted medical school, William began an apprenticeship program wherein soon-to-be doctors were carefully taught medical anatomy, physiology, and disease pathogenesis for the first few years. Thereafter, William would take the medical students out of the lecture halls and place them into clinical settings. His ‘bench to bedside’ approach taught students how to take a medical history & how to perform a physical exam and then how to use the data gathered, together with their classroom knowledge, to establish a diagnosis. As he would say on endless occasion, “Listen to your patient, for he is telling you the diagnosis.” He taught students not only to take a disciplined approach to diagnosis but to also do so with the highest ethics, values, and professionalism to the patient suffering from the disease: “The good physician treats the disease; the great physician treats the patient with the disease.” After medical school ended, medical students stayed on the hospital’s faculty as ‘house staff’, at which point these ‘residents’, who literally lived in the hospital, continued their apprenticeship program for up to another 5 to 7 years, performing daily ‘rounds’ with the patients. As the medical experience of the residents increased, they passed on the knowledge to the newer house staff in the hospital.
Today, Dr. William Osler is regarded as the “Father of Modern Medicine.” Sadly, on this day (Dec 29) exactly 101 years ago, the 70 year-old Dr. Osler would succumb to another respiratory virus causing a pandemic – the “Spanish” influenza. Amazingly, Osler made the ultimate sacrifice – he died caring for patients. A century later, many healthcare providers are following his lead. As they meticulously care for millions with COVID-19 infection, they are learning with each patient they see and treat and passing on this knowledge to their colleagues and the entire medical community.
The practice of medical apprenticeship lives on today, much like the legacy of Osler as the profession’s most revered clinician, humanitarian, and teacher.
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