As I enter my 50th year as a physician, I recognize that my patients have been my best teachers.
In the late 19th century, Sir William Osler became the first physician to bring medical students out of the classroom, for bedside clinical training. “To study the phenomenon of disease without books is to sail an uncharted sea, while to study books without patients is not to go to sea at all,” he said.
Keeping up with medical literature continues to be overwhelming. But not doing so will perhaps prevent us from offering the best care to our patients. Staying up-to-date -- by reading or attending regional and national conferences -- is crucial for remaining aware of the newest medical advances.
I believe that we physicians must critically evaluate the medical literature, while remembering an old dictum: Those who have great enthusiasm have no data, and those who have data have less enthusiasm.
A thoughtful review of medical literature requires attention to both methods and results. We can find this described, briefly, in a structured abstract, which allows us to get to the heart of what the findings will provide.
A well-structured randomized clinical trial (RCT) -- in which neither patient nor researcher knows what any participant is receiving -- measures the efficacy of an intervention. RCTs are used for both diagnostic and treatment procedures.
Our full understanding of the difference between sensitivity or specificity, and positive vs. negative predictive value, is essential for critically evaluating medical data. Meta-analysis (a comparison of numerous studies) and evidence-based medical reviews are important sources for incorporating high-quality research data into our clinical decision-making. Guidelines published regularly by our medical societies provide practical advice on the management of various diseases that we treat.
In recent years, we’ve frequently had to think about the evolving direction of practicing medicine. We constantly need to reconcile a discrepancy: the medical profession is an art guided by science, yet the “healthcare” we hear so much about is a business.
As physicians, how can we best deal with this dichotomy? Finding the balance remains problematic. I predict it will require substantial thinking about why we entered what I consider a very noble profession.
For me, the ethnic diversity of the population we serve continues to be a source of stimulation. It brings the fascinating need to understand cultural differences and how they might affect disease presentation.
More than ever, I realize the importance of balancing work with other interests outside of medicine and deriving great pleasure from family and friends. I am fortunate to have a son who has chosen to practice with me, for more than a decade. My wife and sister have worked in our office for most of my professional life and have each been a source of continued support both at work and at home.
As I am now 76, patients sometimes ask about when I will retire. “I don’t plan on retiring any time soon,” I tell them. My desire to continue to practice medicine comes from my love of dealing with the many wonderful patients who I have come to know and care for during my half-century as a physician.
-William Erber, M.D.
author, Dr. W.E.; edited Dr. J.E.