Howard Markel, MD, PhD


October 26, 2005

Some time ago, in between sending off a manuscript to a journal for review and making sure an ongoing research project was progressing as scheduled, I received an urgent long-distance call from a colleague. From the tone of her voice, I knew it was bad news. Sure enough, a favorite teacher from our years together as interns and residents, a mild-mannered physician I'll call Ted, had died unexpectedly just hours earlier.

In the high-powered, academic medical center where I learned how to be a doctor, Ted was somewhat of an anomaly. Neither a laboratory-based scientist nor a clinical specialist, Ted was a general pediatrician with an encyclopedic knowledge of the diseases of infancy, childhood, and adolescence. From acne to zoster, he was a professor of pediatrics in the truest sense. Despite the many renowned experts who populated our hospital, it was always to Ted that we brought our most difficult cases -- the ones we simply could not crack on our own.

Much has been written of late about the need to improve medical education in the United States. Patients want doctors who are more humane, ethical, and compassionate. Health maintenance organizations want physicians who are more careful in how they utilize precious healthcare resources. Others are at work devising methods to help physicians keep abreast of the torrential pace of new discoveries about the human body. To achieve these ends, virtually every American medical school has an education department filled to the brim with eager professionals ready to dispense pedagogic advice.

But building smarter, more caring, and cost-efficient physicians is no simple matter. Perhaps the problem begins during the first few years of medical school, which are not unlike a speeded-up version of college. Proto-doctors sit in a lecture hall for hours on end listening to a parade of pontificating professors. They then run home to cram all of their imparted knowledge into their brains -- at least long enough to establish a fluency in the language of medicine. The emphasis is not on the messy business of caring for patients but, instead, on knowing the exact answers to particular queries.

Eventually, medical students are sent to the wards of the hospital, where they must confront the real world of diseases and patients instead of books and lecture notes. There, many students, and not a few interns, panic when they realize that this new world rarely conforms to the rigid framework of a multiple-choice question.

Masters of the art of medicine, like Ted, prove their mettle by showing impatient and bull-headed physicians-to-be how to slow down, how to observe and interpret a river of data, and how to accept the humbling fact that life is complex and that disease is complicated.

Ted taught us how to patiently extract clinical histories from those who might be neither forthcoming nor articulate about their illnesses. He guided us to the interpretation of muddled stories told by distraught, worried parents who had been up all night with their ill children. And he instructed us how to quietly enter a hospital room late at night to check on a patient without waking him or his exhausted parents; how to bundle a crying baby into one's arms and speak in slow, soft cadences in an effort to calm her; and even how to give an injection swiftly and steadily in order to minimize the pain. Most important, he made sure we knew that physicians do not have to know everything but are obliged, when discovering gaps in their knowledge, to fill them quickly by making a visit to the library (or, in this day and age, the Internet).

Ted managed to teach these lessons with an unobtrusive gentleness that allowed us to believe we were making the discoveries ourselves rather than being led to them. In fact, in all the years I knew Ted, I cannot ever recall his presenting a formal lecture. Instead, he always taught by example. Not only was this in tune with his unassuming nature, but with his understanding that it is the only effective way to teach a human being how to be a healer.

Most medical school professors inhabit a world where one is primarily rewarded for publishing papers in medical journals, obtaining large research grants or generating large amounts of clinical income, and being elected to prestigious professional societies. In this world, flashy declarations of such accomplishments almost always trump the acknowledgment that is due to those who devote much of their time teaching medical students how to listen carefully to their patients, how to detect unspoken problems, and how to heal even when your doctor's bag is bereft of magic bullets.

My favorite professor understood which pursuits were most important in terms of improving the nation's healthcare system one physician at a time, and as a result was one of the most successful medical school professors I have ever met. He knew -- and tried every day to teach us -- what the noble Greek physician Hippocrates meant 2500 years ago as he taught his medical students the wise lesson: Life is short, but the art of medicine is long.


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