Lessons from Osler 001

The Master Word

In 1903, William Osler spoke to the students ‘on the occasion of the opening of the new buildings of the medical faculty of the University of Toronto‘ and told them of ‘The Master-Word in Medicine‘:

Though a little one, the master-word looms large in meaning. It is the ‘Open Sesame’ to every portal, the great equalizer in the world, the true philosopher’s  stone which transmutes all the base metals of humanity into gold. The stupid man among you it will make bright, the bright man brilliant, and the brilliant student steady. With the magic word in your heart, all things are possible, and without it all study is vanity and vexation. The miracles of life are with it; the blind see by touch, the deaf hear with eyes, the dumb speak with fingers. To the youth it brings hope, to the middle-aged confidence, to the aged repose. True balm of hurt minds, in its presence the heart of the sorrowful is lightened and consoled. It is directly responsible for all advances in medicine during the past twenty-five centuries.And the master-word is Work, a little one, as I have said, but fraught with momentous sequences if you can but write it on the tablets of your hearts, and bind it upon your foreheads.

William Osler, 1903

No one today could hope to have the same mastery of medicine as William Osler had in his day, just over a century ago. However, there is much to be learned from his work ethic, which was the bedrock of his mastery. Osler’s productivity was exceptional – he taught students, treated patients, wrote the definitive textbook of medicine, performed autopsies, wrote copious observations and published prolifically, built medical museums and libraries, and was the doctor’s doctor.

The intellect of man is forced to choose
perfection of the life, or of the work,
And if it take the second must refuse
A heavenly mansion, raging in the dark.
When all that story’s finished, what’s the news?
In luck or out the toil has left its mark:
That old perplexity an empty purse,
Or the day’s vanity, the night’s remorse. 

‘The Choice’ by William Butler Yeats

To be called a workaholic today is akin to being diagnosed with disease. Indeed, the balance between work in medicine and life out of medicine is hard to achieve. It was no less so for Osler than it is for us today.

Some would argue that Osler’s success in finding this balance was limited. After all, his intense devotion to medicine in his younger years meant that he delayed marriage until his early forties. But what cannot be questioned is that Osler succeeded in setting his priorities and meeting his obligations, though these changed with age.

Osler’s success came from thinking and acting positively, never complaining, cultivating his relationships at work and at home, maintaining interests outside of medicine, and exercising his a rare talent for making work fun. For Osler, work was play, play was work. There was no choice to make. Osler loved his work.

Sir William Osler at work
Osler at work (Johns Hopkins Archives)

Most of today’s medical students belong to ‘Generation Y’. The merit of naming generations according to the alphabet can be decided by the reader – is there really a difference between being born in 1981 and 1982? Regardless of the answer, the post-1981 generation is stigmatized by a perceived desire to put lifestyle before work and a predilection to  disrespecting authority.

The young doctor should look about early for an avocation, a pastime, that will take him away from patients, pills, and potions…

William Osler: AequanimitasAfter 25 years’ 1914:212

If alive today, Osler would surely encourage us to question authority, but he would also remind us to respect the skill and experience of those we learn from – even if it be their mistakes that teach us. Osler would also tell us to value our lives outside of the hospital walls, our families, friends and hobbies. But he would leave no doubt that, for those in medicine, sacrifices need to be made. However the sacrifice is diminished if all you do – at work and at play – is part of a purposeful life.

As a skeptic of the fad of generation-bashing, I suspect the criticisms of Gen Why are not unique to today’s youngsters. I suspect it is merely the latest revolution of a cycle that has continued for thousands of years and will continue as long as there are humans with greying hair:

The children now love luxury; they have bad manners, contempt for authority; they show disrespect for elders and love chatter in place of exercise. Children are now tyrants, not the servants of their households. They no longer rise when elders enter the room. They contradict their parents, chatter before company, gobble up dainties at the table, cross their legs, and tyrannize their teachers.

attributed to Socrates by Plato.

Regardless of generation, students of medicine – and we are all students – would do well to heed Osler by writing the ‘Master Word’ on the tablet of their hearts.

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the person behind the name

Chris is an Intensivist and ECMO specialist at the Alfred ICU in Melbourne. He is also a Clinical Adjunct Associate Professor at Monash University. He is a co-founder of the Australia and New Zealand Clinician Educator Network (ANZCEN) and is the Lead for the ANZCEN Clinician Educator Incubator programme. He is on the Board of Directors for the Intensive Care Foundation and is a First Part Examiner for the College of Intensive Care Medicine. He is an internationally recognised Clinician Educator with a passion for helping clinicians learn and for improving the clinical performance of individuals and collectives.

After finishing his medical degree at the University of Auckland, he continued post-graduate training in New Zealand as well as Australia’s Northern Territory, Perth and Melbourne. He has completed fellowship training in both intensive care medicine and emergency medicine, as well as post-graduate training in biochemistry, clinical toxicology, clinical epidemiology, and health professional education.

He is actively involved in in using translational simulation to improve patient care and the design of processes and systems at Alfred Health. He coordinates the Alfred ICU’s education and simulation programmes and runs the unit’s education website, INTENSIVE.  He created the ‘Critically Ill Airway’ course and teaches on numerous courses around the world. He is one of the founders of the FOAM movement (Free Open-Access Medical education) and is co-creator of litfl.com, the RAGE podcast, the Resuscitology course, and the SMACC conference.

His one great achievement is being the father of three amazing children.

On Twitter, he is @precordialthump.

| INTENSIVE | RAGE | Resuscitology | SMACC

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