What is important to teach

November 11, 2009

Tonight I worked a shift with an exceptional medical student from a fine school who had never heard of Ignaz Semmelweiz.

Tonight I worked a shift with an exceptional medical student from a fine school who had never heard of Ignaz Semmelweiz.

My student didn’t recognize his name, but more importantly, this talented and engaging medical student had never heard the tragic story of the great physician who deduced the etiology of puerperal fever (physicians performing autopsies and then delivering babies without washing their hands), who was ridiculed when he proposed that physicians were the fomites responsible for peripartum infection and death, who lost his mind, most likely due to tertiary syphilis (an occupational hazard of 19th century gynecologists), and who died in a mental institution after a savage beating at the hands of other inmates.

Similarly, this particular student had never heard of Werner Forssman, the German physician who won the Nobel Prize in medicine by demonstrating the feasibility of introducing a catheter into the right atrium of the heart via a peripheral vein - an experiment he performed initially on himself.

Why is the history of medicine not taught in medical schools? How can modern day medical students appreciate their place in the continuum of medicine and their place in history and their responsibilities to past and future generations of physicians unless they learn the great and noble and honorable and not-so-honorable accomplishments of the men and women that have made their marks on our world’s history?

What about the history of medicine through fiction? Sir Arthur Conan Doyle was a physician (many people believe that Dr. Watson was his literary alter-ego). In addition to the adventures of Sherlock Holmes, Conan Doyle wrote numerous short stories about being a physician in 19th century London. Reading Conan Doyle’s “Round the Red Lamp,” one realizes the shared experience of despair at the bedside of a dying patient. Helpless to do anything to stop the inevitable, the great and awful responsibility we have as physicians reaches down through the ages from gaslight to halogen bulbs.

Last year I gave as a graduation present to each of the residents in my department a copy of William Carlos Williams’ “The Doctor Stories” in the hopes that they might see something of themselves in these beautiful stories of doctors and patients from the mid 20th century.

The student that I worked with tonight was born in 1982, which was my sophomore year in college. She grew up in a world that has never not known AIDS. I instruct my residents to consider what it must have been like to practice medicine in the age of polio and rampant tuberculosis and yellow fever, and how the physicians of that age were intimately familiar with those diseases.

Then I ask them to consider the future, when HIV has been conquered and the physician of the next century is dealing with whatever new pathogenic horror has developed. The physician of the future might ponder what it must have been like to practice in the age of AIDS, and I remind them of the awesome responsibility that they have each agreed to.

Gerald O'Malley, DO, is the director of research in the largest, busiest emergency department in Philadelphia and an associate professor of emergency medicine at Thomas Jefferson University Hospital. He’s also the son of a NYC cop, die-hard Yankees fan, and a regular contributor to Practice Notes.