>> GOOD AFTERNOON AND WELCOME TO GRAND ROUNDS FOR CLINICAL FELLOWS. MY NAME IS ROBERT LIMBO THE EXECUTIVE DIRECTOR OF GRADUATE MEDICAL EDUCATION HERE AT THE NIH CLINICAL CENTER. THIS SERIES OF FIVE PRESENTATIONS DURING THE MONTH OF AUGUST WILL ADDRESS TOPICS RELEVANT TO THE TRAINING COMPETENCIES OF PROFESSIONALS IN MEDICINE INCLUDING ETHICS AND SYSTEMS-BASED PRACTICE AS DEFINED BY THE ACCREDITATION -- AT THE CLINICAL CENTER, WE LOOK FOR WAYS TO CREATE AND ACTIVELY PROMOTE A MORE HUMANISTIC ENVIRONMENT FOR OUR TRAINEES TO CONDUCT RESEARCH AND ENSURE CARE. TO BE HUMANISTIC IS TO BE COMPASSIONATE, RESPECTFUL, ALTRUISTIC, EMPATHETIC AND PATIENT-FOCUSED. WITH THE RAPID GROWTH OF AND INCREASED ATTENTION TO TECHNOLOGICAL MEDICINE DURING THE PAST DECADE, HOWEVER, MANY OPINION LEADER WITHIN THE PUBLIC SECTOR HAVE EXPRESSED CONCERN THAT HUMANISM AS A PARADIGM FOR THE PROCESS OF PATIENT-ORIENTED RESEARCH HAS BEEN DEEMPHASIZED OR IN SOME CASES SIMPLE LE NEGLECTED. TODAY IN HIS PRESENTATION ENTITLED CLINICAL RESEARCH, EVIDENCE BASED MEDICINE IN THE HEART OF HEALING, DR. COLGAN -- HE IS IN THE DEPARTMENT OF FAMILY AND COMMUNITY MEDICINE AT THE UNIVERSITY OF MARYLAND SCHOOL OF MEDICINE, A GRADUATE OF CATHOLIC UNIVERSITY OF WASHINGTON D.C. AND GRADUATED FROM A SCHOOL IN MEXICO. HE MAINTAINED AN ACTIVE PRACTICE BEFORE JOINING THE UNIVERSITY OF MARYLAND AS A FULL-TIME FACULTY MEMBER. SHE'S A DEP MAT OF THE AMERICAN BOARD OF FAMILY MEDICINE AND SERVES AS THE PRESIDENT OF THE AMERICAN ACADEMY OF FAMILY PHYSICIANS. IS RECIPIENT OF THE AMERICAN MEDICAL STUDENT ASSOCIATION TEACHING AWARD AS WELL AS THREE UNIVERSITY OF MARYLAND STUDENT COUNCIL FACULTY TEACHING AWARDS. IN 2011, DR. COLGAN WAS INCLUDED ON A LIST OF BEST DOCTORS IN AMERICA. HE'S PUBLISHED ARTICLES ON A VARIETY OF TOPICS. HE IS A REVIEWER FOR THE JOURNAL OF FAMILY PRACTICE, FAMILY MEDICINE, AND THE AMERICAN FAMILY PHYSICIAN. HE'S ALSO THE AUTHOR OF THE BOOK "ADVICE TO THE YOUNG PHYSICIAN ON THE ART OF MEDICINE." IT'S MY PLEASURE NOW TO WELCOME HIM TO THE PODIUM. >> GOOD AFTERNOON, HOW Y'ALL DOING? AND I USED TO WORK HERE OVER 35 YEARS AGO, I WAS A LAB TECH ON THE 12th FLOOR OF THIS BUILDING. DO THEY STILL HAVE HANK SOLUTION, I DON'T KNOW? SO MAYBE THE SUBTITLE OF MY TALK WOULD BE THE QUEST TO IDENTIFY THE ART OF MEDICINE. I'D LIKE TO START WITH A DISCLAIMER AND THAT IS THAT I'M GOING BRING UP A LOT OF LOFTY IDEAS AND THOUGHTS AND THINGS TO IDLEIZE. I DON'T WANT ANYTHING TO THINK THAT I THINK I'VE GOT IT. I DON'T FEEL LIKE I'M AN EXPERT IN ANY WAY SHAPE OR FORM. I LIKE THE QUOTE BY RABBI BENESS KRA, WHAT I ASPIRE TO BE IS NOT A COMFORT TO ME. NO CONFLICTS OF INTEREST AND I WANT TO RECOGNIZE THE IMPORTANCE OF THE ART OF MEDICINE, THE HEALING ARTS OF RESEARCH AND KEEPING OUR FAKS ON THE PATIENT IN ALL THAT WE DO. -- FOCUS. I ONCE HAD A MEDICAL STUDENT, DO YOU THINK YOU CAN TEACH THE ART OF MEDICINE AND NO BUT YOU CAN LEARN IT. WE LEARN BY WORKING ALONGSIDE A SENIOR CLINICIAN OR SOMEONE WHO'S BEEN AROUND FAR WHILE. THESE ARE A COUPLE OF STUDENTS THAT CAME TO MY CLERKSHIP AND THEY WERE DRESSED JUST LIKE ME, NOT INTENTIONAL. I JUST GOT A KICK OUT OF THAT. [LAUGHTER] THIS IS JOHN ARBISTKNOT. HE WAS THE PHYSICIAN TO QUEEN ANN OF ENGLAND AND KNOWN AS AN EXCELLENT PHYSICIAN. HE WAS ALSO A WRITER, A FRIEND OF SWIFT AND POPE. HE WAS NOT VERY CAREFUL ABOUT HIS BUSINESS AFFAIRS. HE DID NOT TAKE CREDIT FOR HIS WRITINGS WHICH BACK THEN MEANT HE WOULDN'T GET PAID. WHEN QUEEN ANN OF ENGLAND DIED, HER ENTIRE COURT WAS DISBANDED. UPON HEARING THAT, JONATHAN SWIFT SAID, HE KNEW HIS ART BUT NOT THE TRADE AND I LOVE THAT QUOTE AND I REMEMBERED IT EVER SINCE READING IT IN COLLEGE. AND I THINK IT MEANS TO IMPLY THAT HE WAS REALLY GOOD AT WHAT HE DID BUT HE WASN'T TOO START SMART OF THE BUSINESS SIDE OF THINGS. MY WISH FOR ALL OF YOU IS THAT YOUR PATIENTS WILL SAY OF YOU WHAT A GREAT RESEARCHER AND SCIENTIST THIS PERSON IS, BUT HE'S MY DOCTOR, SHE'S MY DOCTOR. SO WE'RE GOING TO LOOK IN A VERY RAPID WAY AT COUPLE THOUSANDS OF YEARS AND WE'RE NOT GOING LOOK AT ALL ABOUT THE KIENS OF MEDICINE. THIS IS THE FIRST TIME I'VE BEEN INVITED TO GIVE A TALK AT NIH, PROBABLY THE LAST TIME 'CUZ THIS IS GOING TO BE A VERY ATYPICAL TALK I THINK, I HOPE. BUT I WANT TO TAKE US TO LOOK AT THE ART OF MEDICINE LOOKS LIKE OVER THE AGES BECAUSE THERE'S A LOT OF THINGS THAT ARE COMMON AND TO DO THAT WE'RE GOING START WITH ANCIENT TIMES. IN THE [INDISCERNIBLE] IT WAS ARCHITECT OF THE GRAND PYRAMID AT SIGARA. HE WAS THE FIRSTING IF OF A PHYSICIAN TO STAND OUT CLEARLY FROM THE MIDST OF AN TIG WITTY. HE WAS THE FIRST ARGUE TECH, ENGINEER AND PHYSICIAN IN RECORDED HISTORY. ACHIEVED DIVINE TA STATUS AFTER HIS DEATH. HIS PRACTICE IS WERE VOID OF OF MAGICAL THINKING. PEOPLE THOUGHT THEY WERE ILL BECAUSE THE GODS WERE NOT LOOKING DOWN ON THEM FAVORABLY. THE EGYPTIANS THOUGHT MOST ILLNESSES ASIDE FROM TRAUMA WERE HOSTILITY BAY HIGHER POWER. -- BY A HIGHER POWER. EIGHT SPECIFIC CASES ARE DOCUMENTED INCLUDING INSTRUCTIONS CONCERNING A WOUND FROM THE TOP OF HIS EYEBROW. THIS FOLLOWS DETAILS IN THE EXAMINES OF THE PATIENT AND DIAGNOSIS. HERE, THE PHYSICIAN IS TOLD TO STATE THE INJURY AND THEN WHETHER OR NOT HE CAN TREAT IT. ACTUALLY, THERE WERE THREE THINGS HE COULD SAY. AN AILMENT WHICH I WILL TREAT, AN AILMENT WHEN WHICH I WILL CONTENT, AN AILMENT NOT TO BE TREATED. NOT ONLY WAS HE THE ARCHITECT BUT THE PHYSICIAN AND A LOT OF PEOPLE FELL DOWN THESE STEPS BUILDING THIS. A LOT OF WRITINGS ABOUT FRACTURED SPINES AND OTHERS. STABILIZING THE SPINE WHEN MOVING A PATIENT. THE SMITH [INDISCERNIBLE] REVEALED METHODICAL IDENTIFICATION OF AN AILMENT AND DETAILED CLOSING OF WOUNDS. IN SOURT, HE INTRODUCED RATIONAL SCIENTIFIC PRACTICES BASED ON MEANINGFUL OBSERVATION AND EXAMINATION. TO US THIS MAY SEEM LIKE DUH BUT THIS WAS NOVEL AND NEW AND IT BEGAN WITH HIM. [INDISCERNIBLE] SAID FREEDOM FROM DISEASE THE FIRST BLESSING. THAT'S GOOD NEWS FOR US DOCTORS IN THE AUDIENCE. THAT MEANS JOB SECURITY. AND THE POINT IS, IS THAT ALL CULTURES VALUE GOOD HEALTH. FROM THE TIME OF [INDISCERNIBLE] THAT BAB LONE YAN KING YOUR FAMILIAR WITH THE CODE AND THINGS LIKE THAT BUT YOU MAY NOT KNOW THAT TWO OF HIS CODES WERE DEALING WITH PHYSICIANS. ONE OF THEM WAS THIS: IF A DOCTORS HEALED A FREE MAN'S BROKEN BONE HE SHALL GIVE THE DOCTOR FIVE SHEKELS. SECOND ONE IF THE DOCTOR USED A KNIFE THAT THE MAN DIED, WE'LL CULT HIS HANDS OFF. SOCIETY TAKES CARE OF ITS DOCTORS AND HOLD US ACCOUNTABLE. ALL CULTURES AND COMMUNITIES EVER SINCE HAVE DONE THE SAME THING. WE'RE LOOKING TO GO ON A QUEST TO UNDERSTAND THE ART OF MEDICINE, PARTICULARLY AS IT RELATES TO WHAT YOU'LL BE DOING. IN THIS QUEST, WE HAVE TO THEN TALK ABOUT HI POCKTIES OF COST. THE FOUNDER OF THE HIP KRA TICK SCHOOL OF MEDICINE. ABOUT 400 YEARS AFTER HIS DEATH WHEN HE WERE ASSEMBLING THE LIBRARY, ANYTHING THAT SOUNDED LIKE DETAILED PATIENTS THROUGH IT INTO A PILE AND SAID HI POCKTIES. WE'LL TALK ABOUT CHAPTERS IN JUST A MOMENT. THE [INDISCERNIBLE] OR HI POCKTY'S WORK WAS ANOTHER REASON FOR BRINGING TOGETHER THIS TALK AND WRITING THE BOOK THAT YOU HEARD ABOUT, AND I WAS AMAZED AT ALL MEDICAL STUDENTS KNOW THE FIRST RULE OF HI POCKTIES. ANOTHER ONE WAS, OBSERVE ALL. STUDY THE PATIENT RATHER THAN THE DISEASE. EVALUATE HONESTLY. THERE'S SOME DISHONEST EVALUATORS OUT THERE? WHEN IT COMES TO THERAPEUTICS, ASSIST NATURE. I MENTIONED TWO CHAPTERS THAT ARE PROBABLY ACCURATE AND COME FROM HIPOCRATES. ONE WAS CALLED AFTERISMS. WHENEVER I HEAR THAT SHOCK TRAUMA HELICOPTER OVER HEAD I ALWAYS THINK, EXTREME REMEDIES ARE APPROPRIATE FOR EXTREME DECIDES. ANOTHER ONE IT'S IMPORTANT TO KNOW WHAT PERSON HAS A DISEASE THAN THE KNOW THE DISEASE. SOME OF THESE AFTERISMS WERE FUNNY. DRINKING STRONG WINE CURES HUNGER. A WOMAN DOES NOT COME AMBIDEXTROUS. GOOD TO KNOW. UNIX DO NOT TAKE THE GOUT OR BECOME BALD. THE OTHER BOOK OF APOCKTIES IS BOOK -- APOCKTIES SAID IT'S A POOR PATIENT OUTCOME IF... AND THE HE DESCRIBES THE HIP KRO TICK FACE SIS. SOME OF THE PROGNOSTICS ARE FUNNY. IT'S BEST WHEN WIND PASSES WITHOUT NOISE. NON-CONVENTIONAL TALK HERE. LET TALK ABOUT ARISTOTLE WHO SAID THAT WHEN COMFORT IS THE ONLY REASONABLE GOAL IT'S SOMETIMES WISER TO KNOW WHEN NOT TO MEASURE SOMETHING. I THINK OF THAT ANTIDOTE ERE TIME I MET SOMEONE AT HOSPICE. I WAS TAUGHT WHEN YOU ADMIT SOMEONE THERE, ONE OF THE ORDERS SHOULD BE DISCONTINUE ALL VITAL SIGNS. ANOTHER QUOTE IS NOT EVERYTHING THAT CAN BE MEASURES MATTERS AND NOT EVERYTHING THAT MATTERS CAN BE MEASURED. FROM PLATO, HE WROTE ABOUT FUNCTIONAL ILLNESSES. THE BODY CANNOT BE CURED WITHOUT THE SOUL. THE SYMPATHY OF THE SOLE SOUL IN THE BODY, ANY DEFECT OF E EITHER IS IN DISCOURT CORD OF THE OTHER. ANCIENT HISTORY OF WHY WE WHAT WE DO IN MEDICINE AND ALL DOCTORS SHOULD KNOW THE ORIGIN OF THE WORD MEDICINE AND IT COMES FROM MED IN THE EUROPEAN ROOT WHICH MEANS TO TAKE APPROPRIATE MEASURES. FROM THAT STEMMED THE LATIN WORD MEDARY WHICH MEANT TO LOOK AFTER, HEAL AND HUR. FROM THERE, STEMMED THE WORDS MEDICINE BUT ALSO MODERATE AND MODEST. BENJAMIN SAID TIME IS THE GREAT PHYSICIAN. SOMETIMES THE WISEST PHYSICIAN KNOWS TO DON'T JUST DO SOMETHING, STAND THERE. LOOKING BACK IN [INDISCERNIBLE] YOU SHOULD ALSO KNOW WHERE THE WORD DOCTOR COMES FROM, AND IT COMES FROM DEK AND IT LED TO DOCERI WHICH MEANS TO TEACH. SOMETIMES WE CAN ONLY TEACH PATIENTS WHAT THEY KNOW ABOUT THEIR ILLNESS. YOU'VE GOT A COLD, YOU'LL GET BETTER IN FIVE TO SEVEN DAYS. SADLY YOU'VE GOT LUNG CANCER, IT MAY BE SIX MONTHS. I'M JUST SAYING TO LET YOUR PATIENTS KNOW WHAT YOU KNOW ABOUT THEIR ILLNESS BECAUSE SO OFTEN PATIENTS ARE FRIGHTENED AND UNAWARE AND THEY LOOK TO YOU FOR YOUR EXPERIENCE AND YOUR INTELLIGENCE TO HELP THEM UNDERSTAND WHAT'S HAPPENING TO THEIR BODY. OUR PATIENTS DON'T NECESSARILY WANT A PILL EVERY TIME THEY COME TO SEE US. SOMETIMES WHAT'S WRONG CAN BE HANDLED WITH THE HAND BEHIND THE PILL. FROM DEK ALSO COMES DISCARY WHICH MEANS TO LEARN. DOCTOR COMES FROM THE ORIGIN OF A WORD THAT MEANS TO TEACH AND LEARN. INFORMING OUR PATIENT WHAT IS WE KNOW AND EVIDENCE BASED LEARNING. DIGNITY AND DECENT COME FROM THAT SAME WORD OF THE ROOT DEK. WE'VE COVERED ANCIENT TIMES AND NOW LET'S LOOK AT CHINESE AND MEDIEVAL MEDICINE. THESE ARE APRICOTS, AND I INCLUDED A CHAPTER IN THE SECOND EDITION OF MY BOOK WHICH WILL OUT IN THE FALL -- SHAMELESS SHELF PROMOTION, I GUESS I DO HAVE A CONFLICT OF INTEREST -- ADVICE TO THE HEALER ON CARING AND I INCLUDED A CHAPTER ON CHINESE MEDICINE TO INCLUDE DAWN FANG. HE'S ONE OF THE THREE DIVINE DOCTORS OF JI ON ON. SHE WAS A HIGHLY SKILLED DOCTOR IN THE ERA OF THE THREE KINGDOMS. HE PRACTICED IN THE MOUNTAINS WHERE HIS SKILLS AND DEEDS BECAME LEGEND. IF HE CURED SOMEONE SOMEBODY WITH A SERIOUS ILLNESS HE ASKED THEM TO PLANT FIFE APP COT TREES. IF HE CURED ONE WITH A MINOR AILMENT, HE ASKED THEM TO PLANT ONE TREE. OVERTIME T APP APRICOT TREES BECAME A FOREST. IT SAID HE PUT A SIGN ON HIS PROPERTY THAT SAID, THOSE WHO WANT TO BUY APRICOTS DO NOT NEED TO TELL ME BUT JUST LEAVE SOME RICE. OVER THE YEARS, THE RICE THAT WERE EXCHANGED IN APRICOTS WERE HELPING PEOPLE. HE HELPED MORE THAN 20,000 PEOPLE IN HIS LIFETIME. PEOPLE LATER CAME DO REFER TO CHINESE MEDICINE AS APRICOT TREE FOREST. HE PIONEERED THE IDEA OF COMMUNITY MEDICINE AND SERVICE TO THE UNDERSERVED. HE DREAMED AN IMPOSSIBLE DREAM. THIS IS ROZZIS, ONE OF THE THREE MEDIEVAL PHYSICIANS I'VE INCLUDED; TWO ARE MUSLIM AND ONE IS JEWISH. HE ADVOCATED FOR EVIDENCE BASED MEDICINE BACK IN THE MIDDLE AGES. HE SAID ALL THAT IS WRITTEN IN BOOKS IS MUCH LESS THAN THE EXPERIENCE OF A WIDE DOCTOR. HE URGED PRACTITIONERS TO THINK INDEPENDENTLY AND LEARN FROM EXPERIENCE THROUGH OBSERVATION AND QUESTIONING. HE'S ONE OF THE FIRST TO DESCRIBE SMALLPOX AND MEASLES. HE'S ALSO KNOWN AS THE FATHER OF OPHTHALMOLOGY. HE WAS THE FIRST TO DESCRIBE ALLERGIC RHINITIS AND MAZ. HE TAUGHT THAT TRUTH IN MEDICINE IS AN UNATTAINABLE GOAL. HE ALSO TAUGHT BY THE BEDSIDE. HE TAUGHT HUMILITY AND CAUTION WHEN IT COMES TO UNREALTY EXPECTATIONS TO BEING CONFIDENT. HE URGED THAT WE SHOULD BE ETHICAL AND MORAL ABOUT OUR DAILY ROUTINE. IT WAS OUR DUTY TO SERVE ALL PEOPLE. HE WAS KNOWN FOR TREATING IMPOVERISHED SICK FREE OF CHARGE. WHEN THERE WAS NO HIGH-TECH, ROZZI'S PRACTICE HIGH TOUCH. ADASENI IS THE SECOND MUSLIM. HE WAS A PERSIAN TEACHER OF MEDICINE. HIS BEST-KNOWN WORKS ARE THE BOOK OF HEALING AND THE CANNON OF MEDICINE. IT SERVED AS A FOUNDATION FOR MEDICAL TEACHING FOR SEVEN HUNDRED YEARS. HE ALSO WROTE OF THE NECESSITY OF STUDYING DRUGS BEFORE EXPOSING THEM TO PUBLIC. JUST LIKE CLINICAL TRIALS. HE WAS RECOGNIZED BY OSLER AS THE MOST FAMOUS AUTHOR OF MEDICINE. HE WAS KNOWN FOR PROMOTING POWER OF OBSERVATION AND EXPERIMENT TASTE, A RECURRING THEME. HE PRACTICE EVIDENCE BASED MEDICINE AND HELP ELUCIDATE THE NATURE OF INFECTIONS. HE WAS INFLUENCED BY HIPOCRATES, ARISTOTLE. HE INCORPORATED PHYSICAL, EMOTIONAL AND SPIRITUAL MEDICINE INTO HIS SYSTEM OF HEALING. HE ALSO RECOGNIZED THAT EMOTIONAL ILLNESS COULD NOT EXPRESS PHYSICAL COMPLAINS. A STORY GOES THAT A PRINCE WAS NOT FEELING WELL AND HE WAS CALLED TO THE BEDSIDE. AFTER EXAMINING HIM, HE HELD HIS PULSE FOR A WHILE AND HE NOTICED EVERY TIME HE MENTIONED THE NAME OF THE PRINCE'S GIRLFRIEND WHO WAS DISTANCE AWAY FROM HIM, HIS PULSE BECAME ERRATIC. UPON THE RETURN OF THE GIRLFRIEND, HIS PRINCE WAS CURED. HE PROMOTED SCIENTIFIC STUDY AND -- THE THIRD PHYSICIAN IS MAMONITIS, JEWISH RABBI, PHYSICIAN AND PHILOSOPHER. HE TALKS FOR THE FIRST TIME ABOUT MEDICINE BEING A VOCATION. ETERNAL PROVIDENCE HAS APOINTED ME OVER THE LIFE AND HEALTH OF THE CREATURE. GOD THOU HAS APPOINTED ME TO WATCH OVER THE LIFE AND DEATH OF THY CREATURES. HE'S ONE OF THE FIRST TO REFER TO MEDICINE AS A CALLING. A GREAT STORY ABOUT HIM. I SUSPECT THAT THE ORTHODOX JEWISH MEMBERS OF THE AUDIENCE MAY ALREADY KNOW THE STORY VERY WELL. I JOURNALS CONTACTED HIM AND SAID I WANT TO INTERVIEW YOU. HE SAID NO I'M WAY TOO BUSY. HE WAS A PHYSICIAN TO THE SULTAN. HE MADE GOOD MONEY DURING THE DAYTIME BUT WHEN HE CAME HOME, HE TOOK CARE OF PATIENTS FOR FREE. THE ANTECHAMBERS FILLED WITH PEOPLE BOTH JEWS AND GENTILES, JUDGES AND BAILIFFS, FRIENDS AND FOES. I DISMOUNT FROM MY ANIMAL, WASH MY HANDS, THEN ATTEND TO MY PATIENTS, WRITE DIRECTIONS FOR THEIR AILMENTS. PATIENTS GO IN AND OUT UNTIL NIGHT FALL AND SOMETIMES EVEN UNTIL TWO HOURS AND MORE IN THE NIGHT. I CONVERSE WITH THE PRESCRIBE FOR THEM WHY LAYING DOWN FROM SHEER FATIGUE AND WHEN NIGHT FALLS I'M EXHAUSTED. HERE WE ARE, 20th CENTURY. I ADDED A CHAPTER ON FLORENCE NIGHTIN' GAEL BECAUSE WE CAN LEARN FROM OTHER DISCIPLINES; PSYCHOLOGY AND NURSING AND FROM ALL KINDS OF PEOPLE IN THE CARING PROFESSIONS. THEY CAN LEARN FROM US, BUT WHEN I THOUGHT ABOUT A FEMALE FIGURE FOR THIS TOPIC OF ADVICE TO HEALERS, I ASKED SEVERAL PEOPLE AND THE NAME FLORENCE NIGHTINGALE ALONG WITH MOTHER TERESA AND OTHERS CAME UP. SHE WAS A BRITISH NURSE THAT PIONEERED MODERN NURSING, PUBLIC ADVOCATE WHO DEDICATED HER LIFE TO SERVING OTHERS. SHE WAS BORN INTO A FAMILY WHERE SHE WAS EXPECTED TO LIVE A LIFE OF GENTILITY YET SUCH COMFORTS MEANT NOTHING TO HER. WHY CAN'T YOU BE LIKE OTHER WOMEN? THE RICH DON'T NEED MY HELP. SPENDING HER OWN MONEY ON SUPPLIES, SHE WOULD MAKE NIGHTLY ROUNDS TO THE SICK. SHE ALSO USED THE KNOWLEDGE SHE GAINED FROM BATTLEFIELDS TO PIONEER THE MODERN HOSPITAL. SHE CHAMPIONED HOSPITALS IN LONDON IN 1856. -- ISOLATION OF COMMUNE CAN BELIEVE DISEASES, PERSONAL COMFORT FOR PATIENTS AND WELL-TRAINED NURSE. SHE TAUGHT HER NURSES TO AVOID UNNECESSARY NOISE AS WELL AS NOT -- I THINK THIS TYPE OF ADVICE COULD BE APPLICABLE TO US IN MEDICINE. BEFORE THE BACTERIA ORIGIN OF INFECTIONS DISEASE KNOWN [INDISCERNIBLE] FOR KILLING MORE PEOPLE THAN THOSE DIE IN BATTLEFIELDS, SHE FOUGHT FOR IMPROVED SANITATION. SHE IDENTIFIED THE FOLLOWING FIVE ITEMS AS BEING IMPORTANT TO THE HEALTH OF HOUSES; PURE AIR, PAT WATER, OFFICIAL DRAINAGE, CLEANLINESS AND LIGHT. SHE PIONEERED A NOVEL PIE CHART WHERE SHE WAS ABLE TO DECIDE OR TELL WHERE DIFFERENT MEMBERS OF SOCIETY SUCCUMBED TO DIFFERENT ILL NESDZS AND DIED. IT WAS REVOLUTIONARY. USING THESE TOOLS SHE WAS ABLE TO SHOW THAT IN PEACETIME ENGLISH SOLDIERS WERE TWICE AS LIKELY TO DIE COMPARED TO THE RATE OF CIVILIANS. WORKING PREMISE OF MY TALK IS THAT CLINICIANS IN THE CARING PROFESSIONS CAN WORK FROM OTHERS. FLORENCE'S BOOK NOTE ON NURSING .GIF SOME DETAILS AS TO PRACTICES OF THE ART OF CARE CHG I THINK QUESTION ALL UTILIZE. OBSERVE THE SICK. NEVER LET A PATIENT BE WAKED OUT OF A SLEEP. AVOID UNNECESSARY NOISE. VIEW AND SUNLIGHT ARE IMPORTANCE. LEADING QUESTIONS ARE USELESS. OBTAIN ACCURATE INFORMATION. BE CONFIDENTIAL. OSLER APPRECIATED THE IMPACT THAT NURSING HAD ON PATIENTS AND HE'S GOT SOME REALLY WONDERFUL QUOTES ABOUT NURSES, BUT I WANTED TO SEGUE TO WILLIAM OSLER WHO DID MANY GREAT THINGS. LIVED FROM 1849-1919, EARNED HIS MBA FROM GILL AND TAUGHT ALONG THE BEDSIDE. HE SAID IF YOU LISTEN CLAIREFULLY TO THE PATIENT THEY'LL TELL YOU THE DIAGNOSIS. THIS FATHER OF INTERNAL MEDICINE IS ALSO KNOWN AS FATHER OF PSYCHOSEMATIC MEDICINE. I WAS TAUGHT THIS RECENTLY, THE HAND OF OSLER, SO APPARENTLY IT'S INSPECTION, [INDISCERNIBLE], PERCUSSION. MOST IMPORTANTLY, IT'S CONTEMPLATION, AND I WAS TAUGHT THAT THE MOST IMPORTANT THING A DOCTOR CAN DO IS TO SPEND TIME THINKING ABOUT WHAT THE PATIENT HAS. THERE'S ONLY TWO DIAGNOSIS YOU CAN'T MAKE IN MEDICINE; THE ONE YOU DON'T KNOW AND THE ONE YOU DON'T THINK OF. THIS STROKING OF YOUR BEARD, THIS CONTEMPLATION IS PROBABLY ONE OF THE MOST IMPORTANT THING WE CAN DO FOR OUR PATIENT. HE THOUGHT THAT [INDISCERNIBLE] WAS ONE OF THE HIGHEST THINGS FAR PHYSICIAN. NO QUALITY TAKES HIGHER RANGE. IT'S COOLNESS AND PRESENCE OF MIND UNDER ALL CIRCUMSTANCES. CALMNESS AMID THE STORM. AN EXAMPLE OF A INTERN WHO DIDN'T SHOW INPERTURBABILITY. THERE WAS A CODE IN THE HOSPITAL WHERE I WAS AND THIS INTERN RAN INTO THE ROOM TO ASSIST AND WITHIN 15 SECONDS HE RAN OUT AND SAID, QUICK, SOMEONE CALL A DOCTOR. THE NURSE SAID, YOU'RE A DOCTOR. HE DIDN'T EXACTLY EXHIBIT INPERTURBABILITY BUT THAT WAS NOT HIS FAULT, IT WASN'T HIS NATURE. OSLER ALSO SAID WE COULD HAVE EQUANIMITY WHICH IS HAVING AN INNER CALMNESS. I THINK A WAY OF EXPRESSING THIS MIGHT ALSO BE THE FERSst FIRST PULSE YOU SHOULD TAKE IN A CODE IS YOUR OWN. HE TAUGHT WE SHOULD PRACTICE THE ART OF ATTACHMENT. APPARENTLY BACK THEN DOCTORS LIKED TO DRINK A LOT. HE ADVOCATE FOR THE VIRTUE OF METHOD. GOING IN A VERY ORDERED WAY. OSLER ADD TO SOMETHING. AN EXAMPLE OF THIS MIGHT BE I TRY AND MAKE A METHOD TO MYSELF THAT EVERY TIME A PATIENT SAYS THAT I HAVE A FEVER, I SAY HOW HIGH. IF THEY SAY IF IT'S ABOVE 105, I ASK THEM IF THEY HAVE CHILLS, AND IF SO, I ASK THEM IF THEY VA HAVE SHAKING CHILLS. I FORCE MYSELF TO LOOK UP AND SAY DO YOU HAVE ANY ALLERGIES. IT'S MY ULTIMATE RESPONSIBILITY THAT I DON'T HARM MY PATIENTS. THE LAST CHANCE VI TO PROTECT MYSELF, MY PATIENTS FROM MYSELF IS TO ASK THEM THAT QUESTION AS I'M WRITING THE PRESCRIPTION. SO THE QUALITY OF THOROUGHNESS, GOING HEAD-TO-TOE. IMOTEF DID THAT. LASTLY T GRACE OF HUMILITY. OSLER SAID YOU CAN BEST FULFILL THE HIGH MISSION OF OUR NOBLE CALLING BY HAVING HUMILITY, CONFIDENCE, AND PRIDE. I WANT TO END WITH ACTUALLY TWO THOUGHTS OF OSLER. I RECENTLY AUGMENTED THE FIRST EDITION OF MY BOOK WITH SOME ADDITIONAL MATERIALS THAT I LEARNED FROM DR. CHARLES BRYAN WHO WAS A REAL OSLER FANATIC. EXCELLENT BOOKS IF YOU LIKE OSLER. HE TALKS ABOUT EXAMPLES OF QUALITIES OF OSLER. ONE IS HAVE IDEAL IN WRITING. STUDY TIME MANAGEMENT. THREE, TAKE CARE OF YOURSELF. BY THE WAY, IT'S NOT SELFISH TO LOOK AFTER YOURSELF. RIGHT. AS I SAY IN THE WATER, ONE HAND FOR YOURSELF, ONE HAND FOR THE SHIP. BE A PODSTIVE PERSON. TAKE INTEREST IN YOUR WORK. VALUE EDUCATION. CULTIVATE HUMANITIES. APPRECIATE YOUR FELLOW HUMANS. ACCEPT THE HUMAN CONDITION. WHEN YOU FIND YOURSELF FRUS RATDED OR NOT UNDERSTANDING THING, MAYBE IT'S NORMAL. LASTLY, READ WISELY AND WELL. HE TAUGHT THAT STUDENTS SHOULD HAVE BY THEIR BEDSIDE BOOKS TO READ FOR AT LEAST HALF AN HOUR EVERY NIGHT BEFORE THEY WENT TO BED AND OTHER THAN MEDICINE. OLD AND NUMENT, AND NEW TESTAMENT, OLIVER WENDELL HOMES AND DONE KYOTE. I'M ABOUT 400 PAGES INTO THIS 500-PAGE BOOK IT'S TAKING ME FIVE YEARS TO GET THAT FAR. I'M NOT GOING TALK MUCH ABOUT ELIZABETH BLACK WE'LL. SHE WAS THE FIRST FEMALE MEDICAL SCHOOL GRADUATE. WHEN SHE APPLIED THEY DID A POLL OF THE MALE OPPORTUNITIES STUDENTS. SHE WAS SOMEONE WHO PERSEVERED, WAS HUMBLE, DEDICATED AND SHE DREAMED AN IMPOSSIBLE DREAM. THIS SHOULD BE A FRIEND TO ALL PHYSICIAN SCIENTISTS AND THIS IS FRANCIS WELL PEE BODY, AN AMERICAN EDUCATE, INTERNIST, ALSO A RESEARCHER AND HE HEADED THE THORNDIKE LABORATORIES. IN 1930s, HE NOTED THAT MORE THAN HALF OF HOSPITAL STAYS ASIDE FROM THE INFECTION COULD NOT BE EXPLAINED IN AN ORGANIC BASIS. HE SAID, IT'S THE PHYSICIAN WHO HAS THE MOST TIME TO SPEAK TO THE STRIP NAKED FRIGHTENED AND LONELY PATIENT. HE SAID, CHERISH THIS TIME. BUT I INCLUDE PEE BODY FOR ANOTHER REASON BESIDES THOSE BLUE EYES. THE OH REASON IS HE PROBABLY HAD ONE OF THE MOST POWERFUL QUOTES ABOUT MEDICINE IN THE LAST 100 YEARS EASY AND MANY MANY OF YOU KNOW THIS QUOTE. ONE OF THE ESSENTIAL QUALITIES OF THE CLINICIAN IS AN INTEREST IN HUMANITY. FOR THE SECRET AND THE CARE OF THE PATIENT IS IN CARING FOR THE PATIENT. THIS IS ALBERT SCHWITS RESHGS, HE WROTE ABOUT THE LIFE OF JESUS AND ST. PAUL. HE WENT AROUND EUROPE GIVING ORGAN RECITALS. HE WROTE ABOUT WESTERN CIVILIZATION. HE WAS A PEACE ADVOCATE. HE WON THE NOBLE PRIZE IN 1952. SOME PEOPLE SAY HIS PRIZE-WINNING SPEECH IS THE SINGLE BEST SPEECH EVER GIVEN. I THINK IT'S CALLED THE PRICE OF PEACE AND IT'S ABOUT EXTOLLING RICHER NATIONS AND OTHERS TO GIVE BACK TO THOSE WHO HAVE LESS. HE WAS BORN TO PRIVILEGE AND HE DECIDED TO GIVE BACK WHEN HE TURNED 33. HE BECAME A SURGEON, SET UP A HOSPITAL IN NORTHWEST AFRICA. CLEARLY HE'S SOMEBODY WHO RAN WITH A BRAVE DARE NOT GO. OSLER SAID A MAN IS ETHICAL WHEN LIFE IS SACRED TO HIM. HE RESCUED THIS CAT FROM A BUILDING STRUCTURE IN HIS HOSPITAL SYSTEM AND STORY GOES IS THAT THE CAT LOVED HIM EVER SINCE AND THAT SCWITSER WAS LEFT-HANDED AND DIDN'T WANT TO DISTURB THE CAT SO HE PUT THE PEN IN HIS RIGHT HAND. A GROUP OF NURSES SEND HIM A LETTER SAYING CAN YOU MAIL US BACK WHAT YOUR MOTTO IS. HERE IT S SERVICE. MAY IT BE RECALLED TO YOUR MIND IF EVER YOU'RE TEMPTED TO FORGET IT. IT'LL ALWAYS BE A FAITHFUL XAN YOOND LEAD YOU TO XAPNESS NO MATTER WHAT THE EXPERIENCE OF YOUR LIFE IS. MAY IT TEACH YOU TO DO LIFE GOOD AND SIMPLY AND HUMBLY. ALL OF US HAVE BEEN CALLED TO SERVICE AND I THINK SCHWITZER WILL TELL US WE'LL BE RICH FOR HAVING A LIFE OF SERVICE AND NOT MONETARILY. I WANT TO THROW A COUPLE OF GREATS THOUGHTS OUT HERE. TO THOSE OF YOU WHO HAVE BEEN GIVEN MUCH SH MUCH WILL BE ASKED OF YOU SAID LUKE. ALL HAVE A CHANCE TO BE GREAT WHO HAVE A CHANCE TO SERVE SAID MARTIN LUTHER KING JR. MOTHER TERESA SAYS I DON'T KNOW WHAT THE SECRET OF HAPPINESS IS BUT YOU'LL NEVER BE HAPPY UNLESS YOU'RE SERVING OTHERS. TIME GOES FAST. WE'RE NOW TO THE MODERN ERA. THIS IS PAUL FARMER, HE'S NOT DEAD. HE'S A MD Ph.D.. HE'S DONE RESEARCH. HE'S A PHYSICIAN, ANT POLGS, HEALTH ADVOCATE. ANTHROPOLOGIST. HE DOESN'T LIKE WHEN THE TERM PATIENT SUBSTITUTED FOR THE WORD CLIENTS. WITH THAT YOU SEE THE COMMERCIALIZATION OF HEALTH CARE AND THE SHIFT OF THE PHYSICIAN FROM HEALER TO SERVICE PROVIDER. HE HAS A GREAT QUOTE AND THAT IS, I ARGUE THAT EQUITY IS THE CENTRAL CHALLENGE FOR THE FUTURE OF PUBLIC HEALTH. HE SPEAKS OUT AGAINST STRUCTURAL VIOLENCE, IT MEANS A LACK OF HOUSING, FOOD, WATER AND HEALTH CARE. HERE'S A PHYSICIAN SCIENTIST ADVOCATE WHO MARCHES INTO HEALTH FOR A HEAVENLY CAUSE. SO WHAT DO WE GOT? SCHWITZER WHO LEAVES HIS FAMILY AND GOES TO AFRICA. FARMER LEAVES HOME TO GO TO HAITI AND RUSSIA. YOU HAVE TO WONDER, DO YOU HAVE TO UP AND LEAVE YOUR FAMILY AND GO TO DISTANT LANDS TO DO GREAT THINGS? SCHWITZER HAS THE ANSWER FOR US. EVERYONE HAS HIS OR HER OWN LAMB AURA NAY. HE SAID I'VE MADE MY LIFE MY ARGUMENT. SO WHAT DO THEY HAVE IN COMMON, SCHWITZER AND FARMER. ONE TRIED AND THE OTHER IS TRYING TO RIGHT UNRIGHTABLE WRONGS. DR. CALAMINO FOUNDER OF THE JOURNAL OF MEDICINE PHILOSOPHY, HE LIKES TO GO BACK TO THE BASICS, TO GREEKS AND THE CLASSICS AND OLDER PHILOSOPHY TO EXPLAIN WHAT HE BELIEVES IS TRUE WHICH THAT THERE IS A PHILOSOPHY OF MEDICINE. HE PULLS FROM A WRITING, TELL ME YOUR PHYSICIAN IS HE A MONEYMAKER, AN EARNER OF FEES OR HEALER OF THE SICK? DR. [INDISCERNIBLE] ALSO DID NOT LIKE IT WHEN THE WORD CONSUMERS WAS SUBSTITUTED FOR PATIENTS OR PHYSICIANS WAS SUBSTITUTED FOR PROVIDERS. WITH THAT, COMES A COMMERCIALIZATION OF HEALTH CARE. I INTERVIEWED DR. PALAGRINO AT THE PRESIDENT'S CENTER FOR BIOETHICS AND HE SAID, QUOTE TORQUE ME THE MOST IMPORTANT THING TO ME IN A RELATIONSHIP IS THAT THE HEART OF THE RELATIONSHIP IS A MORAL ENTERPRISE. TEACHER-STUDENT, DOCTOR-PATIENT, POLICEMAN-CITIZEN ALL THESE HAVE A DEPENDENT PERSON WHO NEEDS HELP WHO GOES TO ANOTHER PERSON WHO PROFESSES TO HELP. THEY ENTER INTO A FIDUCIARY RESPONSIBILITY. FOR THOSE OF YOU WHO ARE PHYSICIANED LICENSED IN THE STATE OF MARYLAND YOU'LL PROBABLY AGREE WITH ME, THE MOST FAVORITE READING OF PHYSICIANS IN THE STATE OF MARYLAND WAS THE NEWSLETTER. IT'S ALSO LIKE THIS WITH A LITTLE CLASP ON IT. THIS IS ALSO KNOWN AS THE BAD DOCTOR NEWS LETTER. IT'S ALL THE BAD THINGS THE DOCTORS HAVE DONE THROUGHOUT THE STATE AND LOST THEIR LICENSES FOR. YOU MAY WONDER WHAT'S IN THERE. WELL, IT'S THINGS YOU COULD PROBABLY GUESS; STEALING, FALSE BILLING, NOT STAYING UP-TO-DATE, IMPROPER CARE TO PATIENTS, HAVE IMPROPER RELATIONSHIPS WITH PATIENTS. SO I THINK AND I COULD TELL YOU STORIES UPON STORIES AND I DON'T KNOW THAT TIME WILL LET ME TELL YOU THAT BUT I'LL TELL YOU ONE QUICK STORY. I HAD A PATIENT OF MINE CAME TO SEE ME ONE SATURDAY MORNING CRYING. SHE TOLD ME THAT HER BOYFRIEND WHO WAS ALSO MY PATIENT WAS AN OBGYN DOCTOR PERFORMED AN ABORTION ON HER IN HIS OFFICE. I WOULD SAY TO ALL OF US TO BE MINDFUL OF THE RELATIONSHIP WE HAVE WITH OUR PATIENTS, TO BE CAREFUL ABOUT WHAT GOES ON IN THE EXAMINING ROOM. DON'T UNTIE THAT GOWN FOR SOMEBODY EVEN IF THEY CAN'T REACH IT, GET SOMEONE ELSE TO HELP THEM. IT CAN BE A VERY SLIPPERY SLOPE AND WE HAVE A FIDUCIARY RESPONSIBILITY IF NOTHING ELSE TO YOUR PATIENTS. ANOTHER WAY OF DESCRIBING THE MARYLAND BOARD OF PHYSICIAN FLUZ LETTERS LESSON TO US WOULD BE THAT WE SHOULD LOVE PURE AND CHASE FROM AFAR. I'M GOING MAKE LITTLE PLUG FOR MY INSTITUTION'S UNIVERSITY OF MARYLAND SCHOOL OF MEDICINE IF THERE'S ANY MARYLAND GRADUATE HERE YOU PROBABLY REMEMBER DR. WOODWARD, CHAIR OF THE GARMENT OF MEDICINE, ONE OF THE FOUNDING FATHERS OF INFECTION DISEASE, A RESEARCHER. HE WAS NOMINATED FOR THE NOBLE PRIZE FOR HIS WORK ON [INDISCERNIBLE] TYPHOID. I HAVE A LECTURE BACK IN TEXAS AND WHEN HE HEARD I WAS FROM MARYLAND HE SAID THAT'S WHERE DR. WOODWARD IS AND HE TOLD ME HE'S CREDITED WITH HAVING SAVED HUNDREDS OF THOUSANDS OF LIVES DURING WORLD WAR II BECAUSE OF HIS RESEARCH. HE FOUGHT AN UNBEATABLE FOE, HAD AN INCREDIBLE WORK ETHIC, FAMOUS FOR HELPING OTHERS BE THEIR BEST AND A GREAT SENSE OF HUMOR. TWO REALLY QUICK STORIES. ONE QUOTE OF HIS WAS, DON'T BE A SLIP DOCTOR. SO BACK THEN WHEN YOU ORDERED A TEST, YOU FILLED OUT A SLIP AND THEN PART [INDISCERNIBLE] THE STUDENT TO GO DOWN TO THE LAB. HIS POINT WAS, DON'T THINK YOU'RE A DOCTOR JUST BY ORDERING TESTS. THE OTHER FAMOUS QUOTE BY HIM WAS ONE ABOUT OBSERVATION. THAT WAS, IF YOU HEAR HOOF BEATS BEHIND YOU DON'T LOOK BACK EXPECTING TO SEE A ZEBRA, EXPECT A HORSE. REAL QUOTE IS IF YOU'RE WALKING DOWN GREEN STREET. THOSE OF YOU FAMILIAR WITH BALTIMORE, GREEN STREET USED TO HAVE THESE COBBLESTONE AND WE USED TO HAVE A LOT OF HORSE-DRAWN CARRIAGES CARRYING A FRUIT. DR. WOODWARD WAS ASKED TO GIVE THE ADDRESS AT GRADUATION ONE YEAR AND HE BEGAN BY SAYING OUR NOBLE PROFESSION WOULD BE WELL SERVED IF THE PUBLIC COULD BE MADE MORE AWARE OF ITS HUMAN SIDE. BEING PRESENT DURING THE TIME OF DYING OR IN THE OPERATING ROOM WHEN SURGEONS PERFORM OR ATTENDING FORMER PATIENT'S FUNERAL SERVE THOSE PURPOSES WELL. ACCEPTANCE OF THESE RESPONSIBILITIES AND THE DISCHARGING THEM ARE THE CHARACTERISTICS OF A COMPLETE PHYSICIAN. LESSON THAT DR. WOODWARD CARRIES ON BY DR. KOOLIA, HE MASQUERADED HIMSELF ONE YEAR AND PRETENDED TO BE A PATIENT AND THE DEAN INTERVIEWED HIM. AFTER IT WAS ALL OVER AND DONE WITH THEY THOUGHT HE WAS AN ALCOHOLIC. HE REVEALED HE WAS THE VICE DEAN AND HE GAVE A TALK TO THE STUDENTS. HE SAID, LISTEN, THERE'S GOING TO BE PLENTY OF TIMES WHEN YOU'RE NOT GOING TO KNOW WHAT TO DO, HOW TO CARRY ON OR WHAT TO DO WITH YOUR PATIENT. JUST REMEMBER ONE THING, FOCUS ON THE PATIENT. FOCUS ON THE PATIENT. THOSE WORDS HAVE NEVER LEFT ME AND I THINK OFTEN TIMES IN MEDICINE IN SCIENCE AND RESEARCH AND MAYBE JUST IN A REGULAR EVERYDAY ACTIVITIES WE LOSE OUR WAY A LITTLE BIT AND WONDER WHAT'S THE RIGHT THING TO DO. WHAT I'M NOT SURE I THINK ABOUT HIS QUOTE OF FOCUS ON THE PATIENT. IN HIS BOOK MAKE ROOM FOR SENTIMENT, THE VICE CHAIR OF MED SIP SAID THAT DR. WOODWARD WILL LONG BE REMEMBERED IN MINDS OF PHYSICIANS NOT FROM WHAT HE HAS RECEIVED BUT FOR WHAT HE HAS CONTRIBUTED. WOW. WE'VE GONE THROUGH ABOUT FOUR THOUSAND YEAR; HOW ARE YOU DOING? STILL WITH ME? I WANT TO TALK FOR A FEW MINUTES ABOUT THE HEALER AND THAT'S WHO YOU ARE AND THAT'S WHO I HOPE OUR PATIENTS VIEW US AS; AS SOMEONE WHO KNOWS THE ART AND NOT THE TRADE. I HOPE SOME OF THE STORIES I'VE TOLD YOU HAVE INSPIRED TO YOU WANT TO BE A HEALER AND AS SOMEONE WHO'S PATIENTS REFER TO YOU AS SOMEONE WHO KNOWS THE ART AND NOT THE TRADE. I MENTIONED WE CANEARN FROM NURSES AND FROM DENTISTS AND PHARMACISTS AND PSYCHOLOGISTS AND FROM A LOT OF PEOPLE, BUT WE SHOULDN'T FORGET WHO WE CAN PERHAPS LEARN THE MOST FROM AND THAT'S FROM OUR PATIENTS. SIMPLY PUT T ART OF CARING IS SHOWING LOVE FOR OUR FELLOW MAN THROUGH YOUR UNIQUE SKILL SET. IT'S SO SIMPLE A 12-YEAR-OLD COULD FULLY GRASP IT. JOHNSON WAS BORN HIV POSITIVE-HE CAME TO PUBLIC ATTENTION AFTER BEING DENIED OF FROM A SCHOOL. HE WAS KEYNOTE SPEAK TORE THE AIDS CONFERENCE HE ENCOURAGED ACCEPTANCE TO REMEMBER THAT THEY ARE NOT SO DIFFERENT. HERE'S WHAT HE SAID. CARE FOR US. ACCEPT US, WE'RE ALL HUMAN BEINGS. WE'RE NORMAL. WE HAVE HANDS, WE HAVE FEET. WE CAN WALK, TALK. WE HAVE NEEDS JUST LIKE EVERYONE ELSE. DON'T BE AFRAID OF US, WE'RE ALL THE SAME. HIS LIFE STORY WAS PROFILED IN JIM MOOTEN'S BOOK, WE'RE ALL THE TAME SAME. AS HE WALKED OUT OF THE ROOM, ENCOSI REMINDED HIM THAT HE HAD NOT ASKED ABOUT HIS IMPENDING DEATH. JIM STOPPED AND SAID WHAT ADVICE DO YOU HAVE FOR OTHERS. WHAT HE SAID WAS ONE OF MY FAVORITE QUOTES VI ON THE DOOR OF MY OFFICE AND I WANT TO TELL YOU WHAT THAT QUOTE WAS. ON HIS DEATH BED JOHNSON SAID, DO ALL YOU CAN WITH WHAT YOU HAVE IN THE TIME YOU HAVE IN THE PLACE YOU ARE. THIS IS A PICTURE OF THE DOCTOR. IT'S A PAINTING THAT PROBABLY IS THE SINGLE GREATEST PAINTING THAT FAVORABLY DEPICTS MEDICINE OVER THE PAST 100 PLUS YEARS. STORY GOES THAT SIR LUKE FIELD'S SON DIED OF TE, BUT LOWS SIS ON CHRISTMAS MORNING AND ONE THEORY IS THAT IT REPRESENTS THE LASTING IMPRESSION FIELDS DOCTOR MADE ON THE ARTIST AS HE TOOK CARE OF HIS DYING SON. THIS PAINTING IS DIFFERENT AND I'M SURE MANY OF YOU ARE FAMILIAR WITH IT. I LOVE IT FOR MANY REASONS. HERE, WE HAVE A WELL-TO-DO PHYSICIAN WHO COMES TO THIS COTTAGE WITH A DIRT FLOOR TO CARE FOR THIS SICK CHILD. I'D LOVE FOR YOU TO GO ONLINE AND CHECK O THIS OUT. THE LITTLE GIRL'S HAND IS NEITHER FULLY OPEN OR CLOSED. SHE'S IN-BETWEEN LIFE AND DEATH. THIS PHYSICIAN SCIENTIST HAS TRIED MULTIPLE POTIONS AND NOTIONS AND RECIPES TO TRY AND HELP CURE HERE AND THESE ARE HIS EXAMPLES OF DIFFERENT THINGS HE TRIED AS HE MIXED HER MEDICINE WITH A MORTAR AND PIS L BY THE BEDSIDE. THE MOTHER IS DISTRAUGHT AND HER HEAD HUNG DOWN LOW AND THE FATHER DOING WHAT MANY OF US DO IS JUST STANDING THERE WITH HIS HANDS ON HIS WIFE. THIS IS NOT MEND MEANT TO BE A DEPRESSING IMAGE BECAUSE THIS IS PART OF THE HISTORY OF ART THAT I DON'T KNOW MUCH ABOUT BUT I READ THAT WHAT TO PAY ATTENTION TO IS THE FACT THAT THERE IS LIGHTNESS IN THE WINDOW AND THIS REPRESENTS THE DAWN, REPRESENTS HOPE FOR THIS CHILD AND, IN FACT, STORY GOES THAT THE CHILD DID DO WELL. SO, ANTHONY, CAN WE HAVE THAT CLIP? IN CLOSING THIS HAS BEEN A QUEST TO LEARN THE ART OF MEDICINE, TO LEARN HOW WE CAN MAKE THE TRANSITION FROM TECHNICIAN TO HEALER AND I KEEP THINKING ABOUT CYOTES SO I WANT TO TURN TO THE WORDS OF THIS MAN. >> PRIVILEGE TO DREAM * THE IMPOSSIBLE DREAM * * PROVIDE THE INBEATABLE FOE * TO BEAR WITH UNBEARABLE SORROW * TO RUN WHERE THE BRAVE DARE NOT GO * * TO RIGHT THE UNRIGHTABLE WRONG * TO LOVE PURE AND CHASTE FROM AFAR * * TO TRY WHEN YOUR ARMS ARE TOO WEARY * * TO REACH THE UNREACHABLE STAR * THIS IS MY QUEST TO FOLLOW THAT STAR * * NO MATTER HOW HOPELESS, NO MATTER HOW FAR * * TO FIGHT FOR THE RIGHT WITHOUT QUESTION OR COURSE * * TO BE... [INDISCERNIBLE] FOR THE HEAVENLY COURSE * * AND I KNOW IF I'LL ONLY BE TRUE TO THIS GLORIOUS QUEST * * THAT MY HEART WILL LIE PEACEFUL AND FULL WHEN I'M LAID TO MY REST * * AND THE WORLD WILL BE BETTER FOR THIS * * THAT ONE MAN SCORNED AND COVERED WITH SCARS * * STILL STROLL WITH HIS [INDISCERNIBLE] COURAGE * * TO REACH THE UNREACHABLE STAR * THIS IS MY QUEST TO FOLLOW THAT STAR * * NO MATTER HOW HOPELESS, NO MATTER HOW FAR * * TO FIGHT FOR THE RIGHT WITHOUT QUESTION OR COURSE * * TO BE [INDISCERNIBLE] FOR THE HEAVENLY COURSE * * AND I KNOW IF I'LL ONLY BE TRUE TO THIS GLORIOUS QUEST * * THAT MY HEART WILL LIE PEACEFUL AND CALM WHEN I LAY TO MY REST * * AND THE WORLD WILL BE BETTER FOR THIS * * THAT ONE MAN SCORNED AND COVERED WITH SCARS * * STILL STROVE WITH HIS [INDISCERNIBLE] COURAGE TO LIVE... * THE UNREACHABLE STAR [APPLAUSE] >> I WOULD LIKE TO THANK DR. COLGAN FOR HIS VERY INTERESTING PRESENTATION.