Reflections on Medicine - August 2008
Tex Med. 2008;104(8):20-21.
By Elgin W. Ware Jr., MD
A friend of mine remarked in casual conversation a while back that he thought our generation of doctors was the greatest generation of physicians ever, I presume borrowing the concept of Tom Brokaw's book The Greatest Generation . The more I thought about this, the more I wondered what he meant by this and if this were really true.
The French philosopher Voltaire once wrote, "I will discuss with you anything you want to discuss, but first define your terms."
First off then, what did my friend mean when he said "our generation"? I believe a generation customarily is considered to be 20 years, so this would not fit my friend's conjecture. After further thought, I decided that in all likelihood his reference applied to those doctors typified by the members of TMA's 50-Year Club, those of us who graduated from medical school 50 years or more ago. If this is to be implied by the "greatest generation," I presume the case could be made if one considers the huge strides made by medicine over the past 50 years.
And, preceding those strides, many other advances during this greatest generation, but before their professional career, would have to be considered: such things as the discovery of penicillin and the sulfonamides, advances in military and battlefield medicine, improvements in preventive medicine and public health, and many others.
Beginning after World War II, this "greatest generation" witnessed and indeed was involved in a veritable explosion of knowledge in all areas of medicine, discoveries, and advances far too many to enumerate. And the beat goes on.
But in all fairness, do all these accomplishments make ours the "greatest generation"? One has only to consider the long history of medicine beginning with discoveries made long before Hippocrates to appreciate those insights and discoveries made through the centuries - insights and discoveries that have made our present-day professional capabilities what they are now. Sir Isaac Newton once said, "If I see further than other men it is because I stand on the shoulders of giants."
Currently, the contributions of those physicians even predating Hippocrates and after him through the ages - Galen, Vesalius, Paré, Harvey, Sydenham, Jenner, Pasteur, Roentgen, Osler, and countless others - contributed mightily to medicine as we know it today. Could any of these previous physicians' eras deserve to be called the "greatest generation"? Who's to say - first define your terms.
The more I thought about my friend's remark, the more I began to realize that he was not really basing his assessment on those objective aspects of medical practice, i.e., medicine as a science, but rather on a more subjective side - medicine as an art.
Sir William Osler, in one of his lectures, made the statement, "It is much harder to acquire the art than the science," and he further stated, "The old art cannot be replaced, but must be absorbed by the new science." And, from Hippocrates, "Life is short but the art is long."
So of what does this so called "art" consist? I like to think that the most significant part of this concept, and what I feel that my friend meant to imply, is nothing more or less than a sincere and compassionate care and caring for the patient. The 17th century physician Thomas Sydenham incessantly reminded doctors that their primary duty was to get to know and care for their patients. To some older physicians, this is an attribute seemingly often lacking in the younger generation - to their and their patients' detriment. Their excuses include those of time restraints, the advent of third-party payers, government interference in the practice of medicine, and so on, mostly true.
Nevertheless, and in spite of these rationalizations, the noble attributes described in Robert Louis Stevenson's short essay titled "The Doctor" and the evident selfless caring and disregard for time and fatigue depicted in Sir Luke Fildes' painting of the doctor sitting at the bedside of a dying child should never ever be overlooked or disregarded, regardless of generational membership. As so succinctly and so well put by Osler, the duty of the physician is to "cure sometime, to relieve often and to comfort always."
So what does the future hold? Conquest of malignant disease, of coronary and vascular diseases, a life expectancy of 150 years? Who's to say? Work in nanotechnology, in increased knowledge of the brain and its functions, in biomedical advances such as robotic surgery, and in countless other areas makes one wish he could live long enough to see these come to fruition. Lord Tennyson in his epic poem "Locksley Hall," states, "For I dipt into the future, far as human eye can see, Saw the vision of the world and all the wonders that would be." Would that we could be so lucky. As someone said, "The past is history and the future is mystery." Again from Voltaire, "Much remains to be known about these things."
So how should we leave it? The greatest generation of doctors? Perhaps. But for the generations to come, in spite of whatever their scientific accomplishments might be, it is to be hoped that their claim to greatness might be marked not only by those scientific advances, but more importantly, on an awareness and a continuation of their long heritage of those qualities that are a vital component of the Art of Medicine.
Dr. Ware is a retired urologist living in Dallas. He served many years as a delegate to TMA from the Dallas County Medical Society, of which he was president in 1976. He was a trustee of TMA from 1980 through 1990 and a trustee of the TMA Foundation from 1981 through 1995. He currently is director of a small clinic at The Stewpot, serving the indigent people of Dallas. Dr. Ware continues as a member of the TMA History of Medicine Committee.
Editor's Note: This is the latest in a continuing series of essays by members of the TMA 50-Year Club .
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