by Barron Lerner, MD
One of the unexpected pleasures of writing a biography about my physician-father was creating a sort of genealogy of famous physicians who had preceded him. “Great doctor history” is out of vogue, but it was still exciting to create a path backwards from my father to the legendary William Osler, one of the founding fathers of both the Johns Hopkins School of Medicine and medical education more generally. These physicians were not only great clinicians but humanists. Their stories provide important lessons for modern medical practice.
My father, Dr. Phillip Lerner, was fortunate to attend Cleveland’s Western Reserve School of Medicine in the 1950s, just as it was reforming its curriculum to a more interactive, patient-centered model. Traditional medical education involved two years of lectures followed by two years of clerkships. But Western Reserve got its students involved in patient care — including house calls– beginning right in the first year.
After leaving Western Reserve, my father trained in infectious diseases in the early 1960s at Boston’s Tufts-New England Medical Center. His mentor there was Louis Weinstein, who he later described as a “mesmerizing, dynamic teacher who is fanatic, encyclopedic, opinionated, scholarly and demanding of his specialty and all those who aspire to it or intersect its vast boundaries.”
Weinstein had focused on infectious diseases before it was a recognized field. He acquired vast clinical experience at the Haynes Memorial, an isolation hospital located near Boston, at which he saw many infectious diseases which were on the decline, such as diphtheria, scarlet fever and whooping cough. When Boston obstetricians were unwilling to help, Weinstein personally delivered babies from four women who had severe polio and were in iron lungs.
Weinstein’s mentor had been the brilliant clinician and researcher Chester Keefer, the chairman of medicine at Boston University School of Medicine whom Weinstein had met as a medical student there in the early 1940s. It was Keefer who sent Weinstein to the Haynes and also gotten him involved in research on the new wonder drug, penicillin, that would revolutionize the treatment of previously fatal infections, like pneumonia and endocarditis. During World War II, Keefer was America’s “penicillin czar,” carefully allotting the limited supply of the medication.
Keefer had come to Boston University from Harvard Medical School, where one of his colleagues had been Soma Weiss, a charismatic and warm Hungarian-born physician who tragically died in 1942 at the age of 43. Weiss was the first doctor to describe carotid sinus syndrome, in which pressure on the carotid artery causes a loss of consciousness; along with George Mallory, he described bleeding due to a ruptured stomach vessel, now called a Mallory-Weiss tear. Weiss always said his expertise came from listening closely to patients’ symptoms. Weiss and Keefer co-led grand rounds at the Boston City Hospital, genially arguing and showing off their encyclopedic knowledge.
In the audience at these sessions was a house officer named Paul Beeson, who was born in Montana and got his medical degree from McGill University in 1933. In a career that ranged from Emory to Yale to Oxford, Beeson did path breaking research on hepatitis, endocarditis and fevers of unknown origin. But Beeson was probably most revered for his great humanity. On rounds as the chairman of medicine at Yale, he taught medical students and residents to care deeply, showing quiet attention to each individual patient.
Beeson never met William Osler. Nor did Beeson’s father, John. But, as a general practitioner in Montana, Alaska and Ohio from 1902 to 1957, the elder Beeson felt that he knew Osler, having practically memorized the 1892 edition of Osler’s textbook, “The Principles and Practice of Medicine.” In addition to writing the most important text of his era, Osler was America’s best-known internist, an exceptional diagnostician and teacher. And he eloquently warned of the dangers of specialization and drugs. “The good physician treats the disease,” he wrote. “The great physician treats the patient who has the disease.”
These words, I believe, trickled down over generations to my father. He was a “24/7” doctor, who always put his patients first—making an extra set of rounds in the afternoon, giving patients our home phone number, staying in touch with his colleagues during our family vacations and, most importantly, believing it was his duty to get his patients to make the right decisions.
With the Affordable Care Act, practice guidelines and treatment algorithms, modern practitioners run the risk of practicing “cookbook” medicine. Revisiting this legacy of great physicians reminds us that the key to doctoring, and to inspiring future great doctors, remains keeping patients front and center.
Barron H. Lerner, MD, PhD, Professor of Medicine and Population Health at the New York University School of Medicine, is most recently the author of The Good Doctor: A Father, A Son and the Evolution of Medical Ethics, on which this essay is based. Dr. Lerner received one of the Foundation’s first Gold Professorships in the 1990s.