Often referred to as the “Father of Modern Medicine”, Sir William Osler ( 1849-1919) was a Canadian physician and one of the four founding fathers of the world-renowned Johns Hopkins Hospital. His influence on medical education was profound- it was he who pioneered what is now the standard practice of teaching medical students at the patient’s bedside. Prior to this most learning had been done in the “ivory towers” of lecture theatres, libraries and laboratories. And it was also he who conceptualised the “medical team” as we know it in today’s hospital environment, with its pyramid structure of consultant (resident), and underling doctors-in-training of various grades.
He was an eloquent writer and public speaker- and many of his quotes have become standard gems of medical wisdom- the kind that medical students hear trotted out time and again during their training, perhaps not realising that so many are attributable to one man:
“He who studies medicine without books sails an uncharted sea, but he who studies medicine without patients does not go to sea at all”
“Listen to your patient, he is telling you the diagnosis” and
“The good physician treats the disease; the great physician treats the patient who has the disease”
These erudite gems of medical wisdom are as relevant now as they were back in the 1800s, largely because they relate to the timeless art of listening to the patient.
However, the day to day nature of being a doctor has changed quite a bit since Osler’s time. One of the most significant developments is the manner in which information technology is transforming how we assess and treat patients. I am a GP, and lately have started to do some work as an online doctor. Online medicine has grown exponentially in the past decade- apparently health advice is now the second-most popular topic that people search for on the internet, second only to pornography! Recent studies in many countries confirm high numbers of people are accessing prescriptions online, and are consulting with online doctors and other health professionals on a regular basis.
As the concept of seeing an online doctor has become more widespread, there have, understandably been critics, who argue that it may threaten the traditional doctor-patient dynamic. It may be quick, convenient and more economical, but with the doctor and patient separated by a screen, and perhaps lacking a long term relationship, can it really work? What would Sir Osler make of it? Would he be thoroughly unimpressed by the “hands-offness” of it all?
I think the answer to this hypothetical question depends upon how an online doctor service is provided- by whom and to whom. Modern medical training promotes the art of communication- of listening and understanding people. As a medical student and junior doctor, I was educated in this patient-focused way, just as promoted by Osler- and many years working in General Practice have helped me to hone these skills further. I think it would be impossible to be a competent online doctor without having this solid foundation in traditional medicine. A well-trained doctor, will quickly recognise patients or conditions unsuitable for online management- and they can be referred back to a regular clinic. But in many situations, where the illness is mild or well-controlled, and the patient’s need is relatively simple (e.g. a repeat prescription, a medical certificate or a routine blood test), the patient, as Osler might have put it, is “telling you the diagnosis”. It seems reasonable, in an era of ever-increasing healthcare costs, to combine the common sense of patients with the clinical knowledge of an online doctor- and solve as many problems as possible in this economical way.
Osler once said that “the value of experience is not in seeing much, but in seeing wisely”. I think an experienced doctor can be a great online resource for patients, and can help them safely and wisely navigate this brave new world of online healthcare.