Chapter X: The Traditional Clinician

Article excerpt

When I turn my mind to the environment in which I was educated as a physician, to my teachers and my colleagues, a certain radiance surrounds this circle of people. What kind of people were they? What kind of person did I try to become? The general attitude to which I refer is difficult to define. We did not analyze it, we lived it; I only became fully aware of it when I was confronted with the very different conduct of "modern" doctors.

Years ago I coined the (only slightly ironic) term "Grand Seigneur Attitude" to describe the cast of mind, the manners, and the rules of conduct that have distinguished clinicians for a century and a half.

For many of us in Lodz, Poland, my teacher Dr. Jerzy Muszkatenblit-Jakubowski (1887-1967) was the embodiment of a great physician. Born to a middle class Jewish family, in his youth he got involved in leftist politics, knew tsarist exile to the far North, escaped, studied medicine in Paris, served as a military doctor with the Russian Army in World War I, lived through the revolutionary years in Russia, and returned to Poland to become one of Warsaw's most successful practitioners and later the popular and revered teacher of clinical medicine in Lodz. Trained in excellent hospitals, disciple of Huchard, Vaquez, and Widal, at home in three great cultures, having a native's command of the three languages, a friend of Polish, French, and Russian writers, theatre people, painters, and poets, he had broad interests and saw medicine in proper perspective. He realized how helpless we ultimately were, yet he knew, too, what a difference we often were able to make; and he had the calm certainty that ours was a unique art, one that made exceptionally high demands on a person's learning, diligence, judgment, emotional balance, and moral strength. All his diverse interests notwithstanding, Jakubowski had the gift, and the firm habit, of focusing his attention entirely on a patient. While he was listening to a patient's history, examining the patient, pondering a decision, he wouldn't let an irrelevant thought enter his head.

Jakubowski's diagnostic insights which impressed us so much were the workings of his quickly associating mind that drew on a solid medical learning, vast knowledge of life, and intuitive understanding of fellow human beings.

He knew very well that money did not matter, but good name and being faithful to the rules of the art did; and he lived up to his convictions. He calmly dismissed all authorities' attempts to meddle with our work, was smilingly skeptical before high dignitaries, and trustful and invariably attentive to all who depended on him, whether patients, students, or subordinates. Many of us tried to be like him.

Jakubowski was a very special person, but he was a representative of the entire class of traditionally educated clinicians. Many prominent doctors whom I had the privilege to know were "Grands Seigneurs," each of them in his own way.

The traditional medical education, both the medical school, and in particular, the subsequent hospital training in one of the main specialties, instilled in the physicians the belief in their high calling, a conviction that the work they were doing was important and unique. The physicians' lofty status, the power they wielded, and the extreme vulnerability of patients justified especially high ethical standards, set for doctors high above those required from other members of the society.

There always has been a great diversity of individuals in the medical profession, but we should not fail to acknowledge the existence of a typical personality representative of traditional clinicians, one that served as a model, was generally appreciated, and facilitated promotion to the positions of senior consultants and teachers of medicine. This model personality of a traditional clinician was particularly harmonious. With my children and then grandchildren leaving home and entering the world, I often thought of people who would lead them further and influence their destinies; and I always have wished that those teachers, sport coaches, military commanders, civilian bosses might deal with my youngsters the way a traditional clinician would. …