Book contents
- Frontmatter
- Contents
- Illustrations
- Preface
- Chapter 1 Early Days
- Chapter 2 Washington Heights
- Chapter 3 Speyer School for Gifted Children
- Chapter 4 New York University at University Heights
- Chapter 5 To Each His Farthest Star–A Medical Student at Rochester: 1929–1934
- Chapter 6 Duke University Hospital and Its Medical School, 1934–1935
- Chapter 7 Yale Medical School, 1935–1936
- Chapter 8 Return to Duke, 1936-1937
- Chapter 9 You Can Go Home Again
- Chapter 10 My One and Only Wife
- Chapter 11 The Bronx Is the Graveyard for Specialists, 1937
- Chapter 12 The Columbia-Presbyterian Medical Center, 1937 — The First of Its Kind
- Chapter 13 Pearl Harbor and World War II
- Chapter 14 Valley Forge General Hospital, 1942–1945
- Chapter 15 Tinian, 1945
- Chapter 16 Saipan, 1945–1946
- Chapter 17 Return to Columbia-Presbyterian, 1946
- Chapter 18 The Changing of the Guard at the Medical Center
- Chapter 19 An Internist-Diagnostician Rebuilds His Practice
- Chapter 20 The Upjohn Grand Rounds
- Chapter 21 The Iceman Cometh to Park Avenue
- Chapter 22 Songs My Patients Taught Me
- Chapter 23 Mr. J. Peter Grace, Chairman of W. R. Grace and Company
- Chapter 24 Birth of the Upjohn Gastrointestinal Service
- Chapter 25 Roosevelt Hospital, 1962–1965
- Chapter 26 Consultant and Physician to President Herbert C. Hoover
- Chapter 27 Problems at Roosevelt Hospital: The Bête Noir of Full Time
- Chapter 28 Internal Medicine as a Vocation (1897)
- Chapter 29 The Upjohn Service Moves to St. Vincent’s Hospital
- Chapter 30 Helicobacter Pylori and Peptic Ulcer: A Revolution in Gastroenterology
- Chapter 31 Plasmapheresis for Hepatic Coma at St. Vincent’s Hospital
- Epilogue
- Endmatter
Chapter 28 - Internal Medicine as a Vocation (1897)
Published online by Cambridge University Press: 17 March 2023
- Frontmatter
- Contents
- Illustrations
- Preface
- Chapter 1 Early Days
- Chapter 2 Washington Heights
- Chapter 3 Speyer School for Gifted Children
- Chapter 4 New York University at University Heights
- Chapter 5 To Each His Farthest Star–A Medical Student at Rochester: 1929–1934
- Chapter 6 Duke University Hospital and Its Medical School, 1934–1935
- Chapter 7 Yale Medical School, 1935–1936
- Chapter 8 Return to Duke, 1936-1937
- Chapter 9 You Can Go Home Again
- Chapter 10 My One and Only Wife
- Chapter 11 The Bronx Is the Graveyard for Specialists, 1937
- Chapter 12 The Columbia-Presbyterian Medical Center, 1937 — The First of Its Kind
- Chapter 13 Pearl Harbor and World War II
- Chapter 14 Valley Forge General Hospital, 1942–1945
- Chapter 15 Tinian, 1945
- Chapter 16 Saipan, 1945–1946
- Chapter 17 Return to Columbia-Presbyterian, 1946
- Chapter 18 The Changing of the Guard at the Medical Center
- Chapter 19 An Internist-Diagnostician Rebuilds His Practice
- Chapter 20 The Upjohn Grand Rounds
- Chapter 21 The Iceman Cometh to Park Avenue
- Chapter 22 Songs My Patients Taught Me
- Chapter 23 Mr. J. Peter Grace, Chairman of W. R. Grace and Company
- Chapter 24 Birth of the Upjohn Gastrointestinal Service
- Chapter 25 Roosevelt Hospital, 1962–1965
- Chapter 26 Consultant and Physician to President Herbert C. Hoover
- Chapter 27 Problems at Roosevelt Hospital: The Bête Noir of Full Time
- Chapter 28 Internal Medicine as a Vocation (1897)
- Chapter 29 The Upjohn Service Moves to St. Vincent’s Hospital
- Chapter 30 Helicobacter Pylori and Peptic Ulcer: A Revolution in Gastroenterology
- Chapter 31 Plasmapheresis for Hepatic Coma at St. Vincent’s Hospital
- Epilogue
- Endmatter
Summary
At the onset, I would like to emphasize the fact that the student of internal medicine cannot be a specialist. The manifestation of almost any one of the important diseases in the course of a few years will “box the compass of the specialties.”
—Sir William Osler, 1897In 1897, over one hundred years ago, Sir William Osler, the greatest physician of modern times, was invited to lecture before the section on internal medicine of the New York Academy of Medicine. The title was “Internal Medicine as a Vocation.” There was, even in that early day, concern that general internal medicine was being neglected while the subspecialties were fragmenting it. Osler argued with eloquence that general internal medicine was the backbone of medical practice and every effort should be made to strengthen it and to maintain its position as the basic foundation for the education and training of physicians. Many of Osler's arguments for the importance of general internal medicine are as valid today as they were one hundred years ago. Some have lost their relevance in a period of great change in medical education, especially in the postgraduate years. Now, the general perception is that general internal medicine has become very unattractive to the current crop of medical students who are flocking to the subspecialties and the more lucrative procedure-oriented fields of practice. Whereas in the past internal medicine attracted the brightest and the best students with their Alpha Omega Alpha keys, even the best teaching hospitals are having difficulty in matching in internal medicine and find themselves accepting lower-ranking students and foreign medical graduates in order to meet their quotas. In addition, because most of those choosing a residency in internal medicine elect to become subspecialists, our country finds itself flooded with specialists who may end up examining each other and short of men and women providing primary care. The situation is so acute that it has been called a crisis in medicine and there are threats that government intervention and Draconian measures may be needed to correct the imbalance.
What went wrong and how can we fix it? Responding to Santayana's admonition that “those who cannot remember the past are condemned to repeat it,” let us review Osler's defense of the generalist in internal medicine.
Let us start with the definition of a “vocation.” The American Heritage Dictionary (1993) has two definitions of “vocation.”
- Type
- Chapter
- Information
- The Life of the ClinicianThe Autobiography of Michael Lepore, pp. 389 - 399Publisher: Boydell & BrewerPrint publication year: 2002