Why William Osler Matters

When I mentioned his name, the medical students stared at me blankly. “William Osler. Sir William Osler. Do you know who he is?” What followed was mild befuddlement as they shifted uncomfortably in their seats. And then a light went on: “Isn’t he the one for whom they named the painful nodules in the hands and feet that are sometimes found in infective endocarditis?” Another chimed in, “Doesn’t he have something to do with Johns Hopkins Medical School?” Yes, yes, they were getting there. “Anything else?”

There was nothing.

This is what happens every time. Month after month, as I serve as a preceptor for medical students and residents in my internal medicine clinic, these physicians-in-training have little more than a vague apprehension of the “Father of Modern Medicine.” And who can blame them? First, with the sheer volume of information they are expected to “know” (from AA amyloidosis to the Zika virus), they are simply overwhelmed. When I was in their shoes, my father would shake his head telling me I was trying to put ten pounds of manure in a five-pound can. Second, these once-eager learners are now tired. Somehow in a few short years of working from dark to dark, many have sadly morphed from young Mother Teresa to careworn Willie Loman. And finally, no one has taught them why William Osler matters.

Today, William Osler (if his name is mentioned at all) is an anachronism. A figure shrouded in the mists of history, he is remembered as a man of his age dressed in a starched three-piece suit and adorned with a regent mustache. In our mind’s eye, Osler is the stuff of jerky, crackling silent film putting patients through odd diagnostic poses and listening with an antiquated stethoscope. Of course, we acknowledge, he is the eponymous figure for a number of diseases and exam findings. And yes, he is the indispensable man who made Johns Hopkins Medical School and Hospital what it is today. But quickly, we move on. After all, practicing in an age before cardiac stents, chemotherapy, and even antibiotics, William Osler can only serve now as an admirable, if not irrelevant, curiosity.

But is that true? Not at all.

Now, let me be clear, mine is not a plea for us to return to clever, but arcane physical exam maneuvers. Nor is it an entreaty to add additional Oslerian coursework to an already overburdened class of students. Rather, it is a reminder of how, tragically, we have forgotten the point of William Osler’s story and how wayward we have become as a result.

To be sure, we are not the first generation of physicians to wander off course. Ever since one person has tried to heal another, there has been a struggle. Uncertainty and imperfection have been constant companions. Knowledge and judgment have forever required improvement. The duty to serve has often competed with the appetite to gain. And the sheer responsibility of daily bearing another’s burdens can wear down even the most gifted of physicians.

But today, our waywardness seems dangerously unfixable. Everyone is familiar with the tragic statistics of physician depression, addiction, divorce, and suicide, but few investigate why beyond the pat answers of “stress” and “overwork.” We have lost our way, in part, because we have personally assented to what the system has created: a fundamental dehumanization of the practice of medicine. Our patient lists are long and our time is short. The information is limitless and paperwork is oppressive. Algorithms can constrain and metrics often punish. And somewhere, lost in the midst of this, there is a patient who needs our help. This is where the real story of William Osler can help.

The story of William Osler that we have been taught (or not taught) over the years is interesting but ultimately forgettable. But the real William Osler is mesmerizing. Years ago, there came into my possession of book of essays written by the great physician. Dated 1948 and bearing an inscription from a drug company on the inside cover, this collection was given to every newly minted physician upon their graduation from medical school. With essay titles like Aequanimitas, A Way of Life, and Books and Men, Osler is not waxing on some outdated technique of diagnosing aortic insufficiency or miliary tuberculosis—he is talking about life.

Osler’s life and thought wrestles with what I would call the ever-present balancing acts in medicine: intentionality and efficiency, equanimity and empathy, technique and finesse, and knowledge and intuition. Like us, Osler was pulled in too many directions in too little time. He, too, was trying to put ten pounds of manure in a five-pound can. But he made it clear that, notwithstanding the demands of his work, he would not lose his soul in the process.

Osler believed that the greatest teacher of medicine is experience saying, “The student begins with the patient, continues with the patient, and ends his studies with the patient, using books and lectures as tools, as means to an end.” But he also emphasized the need to know the literature. “To study the phenomenon of disease without books,” Osler warned, “is to sail an uncharted sea, while to study books without patients is not to go to sea at all.” To be sure, Osler was a master of efficiency, but never at the expense of intentionality. As biographer Michael Bliss would write, “He had the knack most often found in politicians (though he despised politicians) of giving you all his attention and interest, perhaps taking you by the arm, listening intently, remarking on an encounter years earlier or some other bond you had in common, convincing you that for William Osler at this moment, you are the most important person in the world.” And Osler never lost sight of the patient as the center of his efforts insisting, “The good physician treats the disease; the great physician treats the patient who has the disease.”

Osler was a constant advocate for others. He taught and he mentored, he vouched and he healed, and he counseled and encouraged. Everyone wanted to be like William Osler and everyone wanted to be William Osler. Even the young (soon to be iconic) surgeon, Harvey Cushing, looked at him as a mentor and father figure while Cushing’s own advisor, the genius surgeon William Halsted, was often missing while serving an intractable cocaine habit. In many ways, no one could repay Osler for the great acts of generosity he bestowed upon them. He was simply magnanimous. But when Osler’s only beloved child, Revere, was mortally wounded in the trenches of France during the Great War, it was Cushing who raced from his military post to try to save the boy’s life and to comfort him as “family” in his inevitable passing. One can almost hear the poignant and wordless exchange between Osler and Cushing in the wake of such tragedy. I imagine Osler whispering, “I can never repay you for what you did for my son in his last moments.” And Cushing responding with welling eyes, “I learned it from you.”

As of this writing, William Osler has been gone almost exactly 101 years. And though he received countless accolades ranging from Oxford’s Regius Professorship of Medicine to a Knighthood under King George V, Osler was not simply admired. Described as “our Osler” by countless friends, he was loved. And when Reverend Henry Herbert Symonds eulogized him at his memorial service, he ended with these words: “And he being dead, yet speaketh. As we, and particularly the younger ones among us, meditate upon his character, may something of his great spirit flow into ours, enriching, expanding, ennobling.”

William Osler, to be sure, is more than an outdated suit, a throwback mustache, and an antiquated exam technique; he represents a sensibility that we sorely need today. It is a sensibility to, day after day, do the right thing for the right reason. And by cultivating this sensibility, we will not eliminate our stresses, but we may at least mitigate them. We may even crawl out of the darkness of burnout into the forgotten light of vocation. And that is something—a might satisfying something—which we, as Catholic clinicians, should heartily support.

“Do you know who William Osler is?” I asked the medical students.

“Okay. Then let me tell you.”