Sir William Osler offers timeless example for young ophthalmologists

New Orleans-The wisdom of Sir William Osler, who could be considered the great-grandfather of medical education in America for his innovations, is as applicable today as it was when first articulated more than 100 years ago, according to Ann M. Bajart, MD, FACS. Dr. Osler is famous for changing the way Americans were taught medicine through his belief in bedside teaching.

"His maxim was that a good doctor treats the disease, but a great doctor treats the patient, and that has not changed," said Dr. Bajart, a Boston-based ophthalmologist who spoke during the Women in Ophthalmology symposium at the American Academy of Ophthalmology annual meeting. She discussed Dr. Osler's legacy as part of her advice to young ophthalmologists and physicians in other specialties.

Dr. Osler was born in Ontario in 1849 and after moving to the United States was a professor of clinical medicine at the University of Pennsylvania. He subsequently was recruited to Johns Hopkins Hospital in Baltimore, where he was the first chief of the medical staff in 1889 and one of the first faculty members at the new medical school.

"First and foremost, we should learn to observe the patient, and that [process] starts from the moment the patient gets up from the chair in the waiting room and enters your office. You should look at the patient and see how they are walking, their gait, whether they are depressed, what their affect is, and their hygiene," she said. "Look at their skin. Do they have rosacea? Eczema? Do they have warts on their hands explaining the funny, itchy papillomas on the lids?

"And while you are at it, since I am a cornea and anterior segment person, watch them blink. Do they blink fully? Do they touch their upper lid to their lower lid, because this is a major problem in dry eye patients," she continued. "Take the opportunity to look at the whole patient."

Respect, dignity

Dr. Bajart also urged her audience to respect patients and treat them with dignity. Practice formalities such as introducing yourself to a new patient with your full name and addressing the patient with a courtesy title, as in, "Good afternoon, Mrs. Jones, I am Ann Bajart."

She also advised physicians to keep their priorities straight and not become slavishly devoted to the technology of the modern office. "When you speak to patients, look them in the eye," she said. "Give them your attention, and do not pay attention to the computer. Do not have your back to the patient while you are clicking away, typing into the record."

It also is important to speak to the patient, rather than to the caregiver, even if the patient is very elderly, is a child, or has a mental disability, Dr. Bajart said. Babies and young children will not understand your words, but they will pick up on your body language and facial expressions, and the parents will hear every word, weighing them for signs of your compassion as well as your skill, she said. "Look at them, and speak to them with animation, and you will develop a relationship."

She also recommended speaking to patients at or below their eye level. Doing so puts patients at ease and avoids giving the impression that you are dominating them, she said. Give patients time to explain the reason for the visit, and avoid interrupting too soon.

"Listen attentively to the patient. The patient has a story, and the patient has concerns," Dr. Bajart explained. "It may not be the concern of the referring doctor; ask the patient what their problem is. Listen to the chief complaint. It is important that you address the concerns of the patient as well as the concerns of the referring doctor."