How to be a good doctor - Oslers clinical pearls

How to be a good doctor

1. Osler’s clinical pearls Eric Mugambi BMJ VOLUME 325 28 SEPTEMBER 2002 bmj.com

2. Traits of a good doctor The practice of medicine will be very much as you make it - to one a worry, a care, a perpetual annoyance; to another, a daily job and a life of as much happiness and usefulness as can well fall to the lot of man, because it is a life of self-sacrifice and of countless opportunities to comfort and help the weak-hearted, and to raise up those that fall .

3. A good doctor 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. William Osler

4. Challenges Trying to make doctors ‘too good’ Master several disciplines Insurance specialists, anthropologists, ethicists, marriage counselors, small business owners, economists, social workers Media: doctors miss depression, family / sexual abuse, ignore sub-cultural beliefs Doctors don’t understand computers/ systems Ignore patients spiritual needs

5. In seeking absolute truth we aim at the unattainable and must be content with broken portions. Society is becoming more ‘medicalised’ More social problems, law enforcement, religious e.g. alcohol, stress, violence Expectation on doctors is to know more and more Can doctors assimilate all this information? How well?

6. A good doctor… Must be technically proficient in the craft of medicine Must understand patients in enough breadth to call on a community of skilled healers – nurses, social workers, chaplains, psychotherapists, physio -therapists, yoga practitioners ‘He who studies medicine without books sails an uncharted sea, but he who studies medicine without patients does not go to sea at all.’

7. Doctor must be ‘touched’ by the patient’s life, as well as their illness ‘It is much more important to know what sort of a patient has a disease than what sort of a disease a patient has.’ William Osler

8. A good doctor… Respect people, healthy or ill, regardless of who they are Support patients and their loved ones when and where they are needed Promote health as well as treat disease “The young physician starts life with 20 drugs for each disease, and the old physician ends life with one drug for 20 diseases.”

9. "The killing vice of the young doctor is intellectual laziness." Embrace the power of IT to support people with the best available information, while respecting their individual values and preferences The philosophies of one age have become the absurdities of the next, and the foolishness of yesterday has become the wisdom of tomorrow.

10. Always ask courteous questions, let people talk, and listen to them carefully Look wise, say nothing, and grunt. Speech was given to conceal thought.

11. A good doctor… Give unbiased advice, let people participate actively in all decisions related to their health and health care, assess each situation carefully, and help whatever the situation

12. A good doctor… Use evidence as a tool , not as a the sole determinant of practice; It is much simpler to buy books than to read them and easier to read them than to absorb their contents

13. A good doctor… Humbly accept death as an important part of life; and help People make the best possible arrangements when death is close Courage and cheerfulness will not only carry you over the rough places in life, but will enable you to bring comfort and help to the weak-hearted and will console you in the sad hours

14. A good doctor… Work cooperatively with other members of the healthcare team No human being is constituted to know the truth, the whole truth, and nothing but the truth; and even the best of men must be content with fragments, with partial glimpses, never the full fruition

15. A good doctor… Be proactive advocates for their patients, mentors for other health professionals, and ready to learn from others, regardless of their age, role, or status By far the most dangerous foe we have to fight is apathy - indifference from whatever cause, not from a lack of knowledge, but from carelessness, from absorption in other pursuits, from a contempt bred of self satisfaction

16. The desire to take medicine is perhaps the greatest feature which distinguishes man from animals When did you have your last health check? Have you seen a physiotherapist for your back pain? Have you tried quitting cigarettes? Would you like to know more on your diabetes? Have you tried any diets to lower your cholesterol?

17. The doctor of the future will give no medicine but will interest his patients in the care of the human frame, in diet and in the cause and prevention of disease.  ~Thomas Edison You mentioned your mother had a back problem, has she been to the doctor? When was your last HIV test? Have you been to a dentist? Where did you have your last baby? Did you see a counselor after your miscarriage?

18. SOPs Do not replace ‘good clinical habits’ Used well, they augment patient-doctor relationship Standardize practice – Labs, procedures, Imaging, treatment, admission, referral Improve patient satisfaction Improve patient care Research oriented Reduce work burden

19. Health as an asset Health is a state of complete physical, mental and social well-being and not merely the absence of disease or infirmity - WHO The patient does not care about your science; what he wants to know is, can you cure him?   ~Martin H. Fischer The Lord hath created medicines out of the earth; and he that is wise will not abhor them.   ~Ecclesiastes 38:4 If you are too smart to pay the doctor, you had better be too smart to get ill.  ~ African Proverb

20. The doctor as custodian of health The good physician treats the disease; the great physician treats the patient who has the disease In nothing do men more nearly approach the gods than in giving health to men.  Cicero My doctor is nice; every time I see him, I'm ashamed of what I think of doctors in general.  Mignon McLaughlin, The Second Neurotic's Notebook , 1966 Restore a man to his health, his purse lies open to thee.   Robert Burton The physician should look upon the patient as a besieged city and try to rescue him with every means that art and science place at his command.   Alexander of Tralles

21. Thanks Who ever thought up the word "Mammogram?"  Every time I hear it, I think I'm supposed to put my breast in an envelope and send it to someone - Jan King