ARTICLE: A Year at the Bedside With Osler

AUTHORS: Jason Liebowitz

JOURNAL: JAMA Intern Med. 2017 May 1. doi: 10.1001/jamainternmed.2017.1080. [Epub ahead of print]

He who studies medicine without books sails an uncharted sea, but he who studies medicine without patients does not go to sea at all.

Sir William Osler1

Ask any resident, and he or she will tell you that this oft-quoted meditation from Sir William Osler, the father of modern medicine and guiding light for many an internist, is beautiful in its language yet quaint and seemingly naïve when applied to the present day. What with the unrelenting demands of the ever-beckoning electronic medical records system, the endless cascade of pages and phone calls and emails from colleagues, and the new epicenter of the wards—the resident workroom—replacing the patient’s bedside as the primary locale for patient care, it is sometimes easy to forget that the patient exists at all.

Yet over this past year, my 2 co–chief residents and I have had the remarkable opportunity to experience medicine as it has been, and should be, practiced in the form of a thrice-weekly exercise known as chiefs rounds. During these hour-and-a-half–long sessions, we join a medical student or intern and their entire team in a patient’s room and, together, we hear the medical and personal story of a patient presented in full, with the patient squarely at the center of the conversation as they participate and listen along. Serving as the sage guides through these dialogues are 3 master clinicians at our institution: David Hellmann, MD, Roy Ziegelstein, MD, and John Burton, MD.

What I have come to witness during these sessions is what it means to truly care for and about someone as their medical professional, and it is so often the patient who will tell you just how meaningful this relationship is to them. The simple act of allowing a group of 10 people into one’s hospital room to hear the most intimate details of their lives—their relationships with family and friends, the tragedies they have suffered, the hopes and fears that their illness has inspired—is not a feat to be taken lightly, and we honor this gift through the asking of uncommon questions that tell the patient that he or she is the most important person in the room. Among the questions I have heard Dr Hellmann, Dr Ziegelstein, and Dr Burton ask time and again are: “Everyone is known for something in their family—what are you known for?” “From where do you get your strength?” “What do you think is causing your symptoms?” “Is there anything we haven’t asked you that we should be asking you to take better care of you as a person?” The expression on patients’ faces when asked these questions is often one of being bemused and slightly perplexed—it’s not every day that they are encouraged to reflect on their own strengths and to be included as part of their own diagnostic team. Their answers are invariably poignant and often wholly unexpected. I will not forget the woman who shared with us something she had never told anyone: “I already know what I would like written on my tombstone,” she said. “‘Forever alone.’” Medicine is, at its core, the practice of connecting with another human being on the most fundamental level, and it is only through asking the heretofore unasked questions that allow us to explore and strengthen this bond between physician and patient.

For a link to the full article, click here: http://jamanetwork.com/journals/jamainternalmedicine/fullarticle/2623530?amp;utm_source=JAMA+Intern+MedPublishAheadofPrint&utm_campaign=01-05-2017

Link to abstract online: https://www.ncbi.nlm.nih.gov/pubmed/28459928

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