http://www.medstudents.com.br/clindi/clindi.htm
MARCELLO GOMIDE CAMPOS DE FARIA
MARIA CLARA SCHMIDT LYRA
We decided to call this session “Sir William Osler” to honour this admirable
physician - in our opinion one of the greatest of all times - whose importance
to Medicine and Clinical Practice is unquestionable.
Sir William Osler (1849-1919) an outstanding clinician , left many
contributions to this science, including his text book named “The Principles
and Practice of Medicine”, but his most important legacy was his philosophy,
materialized in many publications, among which we should emphasize his classic
“Aequanimitas with Other Addresses to Medical Students, Nurses and
Practitioners of Medicine” - revered by generations of medical students and
physicians
He once remarked that if he were ever to be remembered he wished to be known
as one who brought medical students to the bedside. Indeed, Osler introduced
routine bedside teachings to modern occidental medicine, and personified our
ideal as a Physician: someone who has not only an extraordinary knowledge of
Medicine, but also a profound respect and benevolence to the Human Being.
The Art of Clinical Diagnosis, which is the real and permanent basis of our
profession, remains untouched until our days. A good physician should be able
to reach the correct diagnosis - or elaborate some diagnostic hypothesis - in
70 to 80% of cases, with a simple (good) clinical consultation , which consists
of a complete medical history and accurate physical examination. Further
investigation is indicated to confirm our diagnosis, not to make
it. We are not expected to treat the exam: first comes the patient standing in
front of us.
“High Tech” is tempting but one should not use shortcuts. Doctors who are
seduced by technical facilities and rely only on such devices risk loosing
their skills as time goes on. Diagnosis obtained through high technical exams
can be an easy solution, but certainly increase the patient’s and Government
expenses and, in most cases, reflect a defensive position of someone insecure
of his own judgement.
Nowadays, the appearance of so many subspecialties and the debate about high
costs in Medicine are topics of discussion, and maybe doctors should stop for a
moment and listen to Sir William Osler’s wise words:
“Observe, record, tabulate, communicate. Use your five senses.... Learn
to see, learn to hear, learn to feel, learn to smell , and know that by
practice alone you can become expert. Medicine is learned by the bedside and
not in the classroom. Let not your conceptions of disease come from words heard
in the lecture room and read from the book . See, and then reason and compare
and control. But see first.”
Would you consider this “Low Tech”?
We are waiting for your comments Marcello Gomide Campos de Faria
& Maria Clara Schimidt Lyra
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