Physician Behavior and Bedside Manners: The Influence of William Osler and the Johns Hopkins School of Medicine

Abstract

The practice of medicine changes with time as we develop better techniques for diagnosis and improved therapies for treatment. The art of medicine remains constant over the millennia because human nature is unchanging. Patients bring fear, anxiety, and self-pity into the exam room. It has always been the doctor's responsibility to calm their fears and provide hope. The accomplished doctor has a bedside manner that is humane and compassionate, empathetic and supportive. Students are taught bedside skills, the art of medicine, by our senior, most experienced clinicians. However, in the past 20 years, more of these professors are laboratory scientists, often deficient or unpracticed in their bedside skills. Bernard Lown, the famous Boston cardiologist, wrote in 1996 in his book The Lost Art of Healing (1) how essential bedside behavior is to good medical care. He expressed his concern that important bedside skills are disappearing in our technology-focused practice of medicine. Several medical schools have recommended a new emphasis on improving professionalism. Jock Murray, former dean of the Dalhousie Medical School, speaking to the American College of Physicians in 2006, commented on the general erosion of professionalism and a growing public cynicism about the profession. He called for a new focus on the three core principles of professionalism: competency, the primacy of patient welfare, and social justice. Professionalism is not an attempt to protect physicians' power and status, he noted, but a call to practice medicine in patients' best interests (2). No physician has exerted a greater influence on how physicians should behave than Sir William Osler. His essays on the practice of medicine, his leadership in medical organizations, and his personal charisma established a paradigm that has served as a model for physician behavior at the bedside. His textbook of medicine, The Principles and Practice of Medicine, first published in 1892 (3), was the bible of rational medical therapy for 30 years. He was the first chief of medicine at the Johns Hopkins Hospital and Medical School, and his leadership at Johns Hopkins transformed American medical care. He led the effort to bring a scientific approach to the care of the patient. Osler famously said, “The practice of medicine is an art based on science” (4) (Figure). Figure Osler at the bedside of a patient. Photo from the Mark Silverman collection. Osler was a unique personality and practiced at a propitious time in medicine. At the end of the 19th century and the beginning of the 20th century, medicine was evolving from a practice based on superstition and tradition into a rational biological science. His bedside manners were based on Victorian morals and their notion of the duties of a gentleman. But like the technophobe and iPad enthusiast of today, he eagerly embraced scientific medicine as the new hope for tomorrow. How did William Osler and the Johns Hopkins Medical School influence our current bedside behavior?