Compassion and the Art of Family Medicine: From Osler to Oprah

Robert E. Rakel, MD, Department of Family Medicine, Baylor College of Medicine, Houston, Texas.

J Am Board Fam Med. 2000;13(6) 

In This Article

Introduction

It is an honor and a privilege to be invited to give the Pisacano lecture. Nick was a good friend and almost singularly responsible for establishing our specialty on a solid foundation of clinical competence and compassionate, comprehensive care. He was also a lover of the arts, especially music and literature. Thus, I have used "the art of family medicine" in my title to reflect on the role of the arts in our discipline, as I think Nick would have appreciated. In fact, Nick once said that "someday, when the Board is going well, I would like to help rebuild the image of the physician. I'd like to see him study Shakespeare and the Bible. Medicine is a scientific discipline based on humanism."[1]

It has been 10 years since Nick's death on 11 March 1990, yet he is still considered the father of family practice. He was a scholarly man of dignity, distinction, and enormous courage, and he was devoted to the highest moral and ethical principles that guide the medical profession. The welfare of the patient was foremost in everything he supported.

Nick played piano to finance his way through medical school, and he remained an excellent player. He was also one of the University of Kentucky's most popular professors. For more than 20 years he taught "Introduction to Human Biology" to a standing-room-only auditorium of 200 undergraduates, and for his last 10 years he taught the course without receiving a salary.

Before the changes of the past century, the practice of medicine could be illustrated by a single picture, a physician seated at a bedside, studying a sick patient and administering the most effective available treatment: compassion. This picture is The Doctor, by Sir Luke Fildes. It shows the caring physician at the bedside of an ill child, concerned, but helpless. Fildes' masterpiece was commissioned by Henry Tate and hangs in the Tate Gallery in London. It was inspired by the memory of the death of Fildes' son in 1877 and by the professional devotion of their family physician, Dr. Gustavus Murray, who attended him. The painting is intended to show the child making the first signs of recovery as dawn breaks through the window.

Another illustration would be the photograph of Sir William Osler at the bedside contemplating, with his attendant students, the physical clues to an elusive diagnosis.

The first image portrays the frustration of a physician who has little to offer the patient and family beyond companionship, compassion, and watchful waiting. The latter image, despite the magnetism of Osler's personality and the awesome presence of his entourage, is equally ineffective. If the patient in question was suffering from pneumonia, then neither physician possessed the potent antibiotics we have today, although these miracle drugs are breeding a new generation of resistant organisms, and thus we may soon have come full circle. Indeed, the mortality from Streptococcus pneumoniae and Mycobacterium tuberculosis infections remains disturbingly high.

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