Each case has its lesson—a lesson that may be, but is not always, learnt, for clinical wisdom is not the equivalent of experience. A man who has seen 500 cases of pneumonia may not have the understanding of the disease which comes with an intelligent study of a score of cases, so different are knowledge and wisdom.William Osler, MD
The greatest difficulty in life and medicine is to convert knowledge into practical wisdom.William Osler, MD
Mentoring is medicine's greatest achievement.Michael A. LaCombe, MD
“In a hospital cafeteria, two residents were arguing over lunch. Oblivious to … [an] unwinnable battle: what was the single most important discovery in the history of medicine? Understand that these were modern doctors with … a trendy impatience with history. … The first resident … argued for the discovery of antibiotics, and with a grand display of entitlement, he began his argument.
‘There is no doubt that the dawn of the antibiotic era is indisputably the beginning of modern medicine. [Antibiotics] … gave physicians more to do than simply monitor the dying patient. …[T]heir discovery has spawned the … discipline of infectious disease…’ Eminently pleased with himself, he leaned back in his chair. But for meager academic salaries, he might have considered an infectious disease fellowship…
The second resident … prided himself on his intuitive leaps and lateral thinking. He could hardly settle for any such simplistic solution … Antibiotics are important and have their place, but … No, my friend, you miss the obvious. He went on his own rebuttal.
The discovery of the computer is the Rosetta stone for medicine. Regard the computer’s applications in medical research. … He had won and he knew it. And the second resident now sat back smugly…
At the end of their table sat an old man in a long white coat. To this elderly physician the first resident appealed. What do you think, sir? he asked condescendingly. What would you consider medicine’s greatest achievement?
You’re both correct as far as you go, which isn’t very far. … And the correct answer to your question may be found … in your asking me … and in my compulsion to answer you, or rather, history’s compelling me to do so. … Alzheimer’s, thought the first resident. Korsakoff’s, thought the second…
The mentor, whispered the old man. What? both residents asked in unison. The old gentlemen stared off as though addressing some imaginary audience, and began.
The mentor is medicine’s single greatest achievement … It started … long before Hippocrates … but just stop and consider Hippocrates himself. There he is, sitting there in his robe, surrounded by colonnades … Through observation, by sheer power of thought, he’s trying to make a science out of what had been only magic and religion. Pretty soon he finds he has a group of young people sitting around him as well, all wanting to learn what he, Hippocrates, knows what is important. So he teaches them all he knows, which is what you’re supposed to do when you’re a mentor.
And then he sends them out into the world. They teach others in turn, each of them becoming a mentor for students, as Hippocrates had been for them. And everywhere they go, teaching students, treating patients, he is right there at their elbows, making sure they do it the right way, and with style. And so it goes through history … well, you know history as well as I do. Clearly they didn’t, so the old man continued.
‘Look at what happens with this mentor business. You have teachers, each with students numbering in the thousands, all linked with each other down through the ages—forming a vast, dendritic coalescence of medical knowledge. Why, you have to be proud just to belong to it, pieces of wisdom yourself! You begin to think of yourself as some living page out of a grand medical textbook.”
And what happens to those young doctors when they are adrift in the world? Do their mentors desert them? Not in their life! A student meets a patient with congestive heart failure, and old man Withering is right there, telling him how much foxglove to use. Or your young doctor is dealt a baffling case, with Sydenham is sitting on her shoulder, making sure she takes down the history correctly…
And so it’s been for me these long years. I’ve carried my mentor everywhere. If I get sloppy, I wonder, “What would he think of me now?” And if I’m in a tight spot clinically, he prods me back to the literature. … When I’m asked to teach, I do so willingly because that is what he did. When I begin to doubt myself, I remember his belief in me. And if I am ready to quit, I can see him standing there before me in his long white coat, with stern look and stethoscope, and I go on.
What has he been for me, this mentor of mine? He’s been like a father to me, but more than a father. He has been a companion in medicine, to help me through the loneliness that medicine can bring and to share with me the joy that medicine can be. My mentor has, through me and those of my students, cared decently and compassionately for countless patients.
…Yes sir, the mentor is medicine’s best invention. All of us doctors need one. That’s what it’s all about. I hope you boys have one yourselves.’
The old man stopped, looked off, and smiled at some distant memory. The residents at the next table had tuned to listen to him as well. The old man got up to leave, nodding to them all. He had a gleam in his eye, and a radiance about him. Was this madness, wondered the residents, or some forgotten brilliance? He straightened his shoulders, and turned with a quote to the residents at the next table: ‘Observation, reason, human understanding, courage—these make the physician.’
Now the old man turned back to the two residents, nodded to them, and turned to walk away. With a hand to his breast, the old man gave a slight bow, turned, and shuffled away. Bewildered, the residents watched him leave, wondered who he was, and why it was that they had never had time for him before.”
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Conflict of Interest: None.
Authorship: The author was the only writer of this manuscript.