Blame Osler.

September 14, 2009
Alan Berkenwald

Working in a hospital, I spend far more time practicing social work and case management than I do medicine.

“Over vast regions of earth today, magic, amulets, charms, incantations are the chief weapons of defense against a malignant nature”. -- The Evolution of Modern Medicine, Sir William Osler, 1913

William Osler is known as the Father of American Medicine. He was a world class physician, the “Doctor’s Doctor” - as physicians all along the Atlantic seaboard would sent their family members to him. He wrote the first American medical textbook. He was so good, he was recruited from Johns Hopkins (which he had turned into a premier medical center) to Oxford, and he never practiced in America again. He left a complicated legacy.. He was a clinical giant. He was the first to describe many disease processes. He invented ‘rounding’. He taught that all acute symptoms should be related to one illness only. He was the first Academician to recognize the impact of poverty upon disease, and the hopelessness that prevents compliance and healing. So, he invented social workers.

Maybe that’s why he never returned to America.

Working in a hospital, I spend far more time practicing social work and case management than I do medicine. In a 10-hour shift my time is not spent on the noble art of diagnosis and treatment.. I have little time to spend at the bedside. I spend my day completing forms for medications and durable goods, of arranging home oxygen and out patient therapies, of transfers and nursing home placements, of signed consents and health proxies. I spend hours on the phone coordinating specialists and discharge plans.

It’s a wonder I have any hours (and I do mean hours) left to do computer order entry — one click at a time – before doing medication list reconciliation forms.

My most important rounds each day are with case management, not the nurses.

I am now skilled in the art of insurance coverage — explaining to patients and families why their insurance won’t let them stay for another day, or cover that medication, or allow home therapies, or cover visiting nurses and personal care attendants. Why they can’t be transferred to a Medical Mecca. Why their stay in the hospital is an “Observation” and not an “Admission,” so not eligible for nursing home coverage.

Does anyone notice that I still practice medicine (on the side)?

Could William Osler ever practice medicine again in this country?

Just what was that "malignant nature” he was referring to?

(Anyone have a charm bracelet that wards off Social Work?)