In the history of medicine, many physicians stand out for quite distinct reasons, especially for their outstanding innovations. However, Sir Robert Hutchison stands out for reasons that may seem quite ordinary in day to day life, yet very extreme in the eyes of those who understand the stories behind the stories.
After Hutchison died, Dr Donald Paterson said: “In Robert Hutchison Scotland, presented to England a young man destined to become a superb physician, an eminent scholar, a great writer, a most inspiring teacher, a shrewd and gifted clinician, and above all the kindest gentleman…”
Sir Robert Hutchison, who was born in October 1871, is well known for his stellar lectures, contemporary clinical sayings, and his books most notably clinical methods first published in 1897. He is known for his famous and intriguing petition to God, which he wrote in 1953. It has come to be known as The physician’s prayer.
“From the inability to let well alone;
From too much zeal for the new and contempt for what is old;
From putting knowledge before wisdom, science before art, and cleverness before common sense;
From treating patients as cases;
And from making the cure of disease more grievous than the endurance of the same;
Good Lord, deliver us.”
In today’s article, we revisit this petition to gain insight, understanding regarding each word in the sentences to check whether Hutchison’s prayer still stands to date. Let’s get started.
From the inability to let well alone
The more we have advanced in knowledge, the more we have been able to lay strategies more geared towards the prevention of disease. It has, however, driven us to a place where pharmaceutical companies are marketing more drugs to improve the conventional wellbeing, take an example of vitamins. We have been able to convince people deemed to be healthy that they are sick, and we have managed to persuade them to take medications to improve their lives. It, in turn, has increased the market for such drugs. Many health workers no longer pay attention to the fact that changing lifestyles can alter many life ailments. Comfortable access to medicines, the so-called over-the-counter medications have slowly driven us into an era of medicalization and disease mongering. We have termed risk factors, diseases. We are reporting disease prevalence in such a manner that we promote a specific drug in the long run. As doctors, including myself, should know when to prescribe and not to prescribe any medications to a patient because this is a life skill that is gained through tremendous reading and paying attention to detail. We are increasingly becoming unable to let well alone, which was a fear that Hutchison had and thus the first stanza of the prayer.
From too much zeal for the new and contempt for what is old
To have zeal means to exhibit great energy or enthusiasm in pursuit of a cause or an objective. Contempt is the feeling that something is worthless or beneath consideration. In 1928, Alexander Fleming, a professor of Bacteriology at St. Mary’s Hospital, London, discovered that first verifiable antibiotic and we entirely recognize it as penicillin. Fifteen years afterwards, American biochemists Selman Waksman, Albert Schatz, and Elizabeth Bugie discovered streptomycin: and in 1944, clinicians used it to treat Tuberculosis, first used at Mayo clinic. From that time, many antibiotics have been invented and brought out to the market to treat different disease conditions, but notably, knowing little about their post-market side effects. The enthusiasm exhibited in using the new treatments has made us forget about the old regimens. As if this is not enough, some drugs have caused severe side effects post-marketing that they have been removed from the market, an example, diethylstilboestrol. As we pick up new engineering science to bring forward in medical practice, we should not forget to realize the old pattern of medication – including the previous treatment modalities. It is a shame to know the drug-drug interactions of Linezolid when you scarcely know any for penicillin and streptomycin per se.
From putting knowledge before wisdom, science before art and cleverness before common sense
Possibly the line that stands out the most, knowledge entails facts, information, and skills acquired through experience or training. Wisdom, on the other hand, is the tone of bearing experience, knowledge, and good judgment. Science is the intellectual and practical activity encompassing the systematic study of the structure and behaviour of the physical and natural world through observation and experiment. Art means the construction or application of human creative skill and mental imagery, typically in a visual strain, producing works to be appreciated primarily for their beauty or emotional ability. Cleverness implies the quality of being quick to understand, determine and devise or apply ideas. If you have a sound mind in practical affairs, you have common sense. We are dwelling in the world where health care providers are knowledgeable, have an all-round approach to scientific articles and are therefore quite apt. But the same group is missing out on the wisdom, artistry and common sense. The exercise of medicine is both an artistic creation and a science – and the latter should never come before the former. Knowledgeable people are proud because they imagine they know it all: those with wisdom are humble and always apologetic. Being wise brings a desire to learn more following an understanding that someone knows little about the topic. For as long as, a health worker puts common sense before cleverness, they will never get amiss. Alas, this is not usually the case, we have got to believe that when you are cunning, you are perfect. It is just not true. You are complete if you have and make use of your common sense. It was Sir Robert Hutchison’s plea to the Lord.
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From treating patients as cases
“I accept a case of COVID-19 in the isolation unit.” It is not befitting, and it should be discouraged. Unfortunately, it is becoming the new norm. The word ‘case’ means an instance of a disease, injury or problem. It has never described any human being. It is rather appropriate to say that I have a patient with COVID-19 in the isolation unit. By default, medical schools teach students to treat patients as human beings, through the building of the doctor-patient relationship and hereafter maintaining it. Randolph Harrison – the founding author of Harrison’s principles and practice of internal medicine always became angry when his students referred patients as cases, emphasizing the importance of being human in both times of joy and suffering. The impression of calling it case notes should also stop, and we emphasize the patient’s history. It was Hutchison’s vision as early as the 1950s. We should keep it in that direction.
From making the cure of the disease more grievous than the endurance of the same
The ability to bear an unpleasant or hard spot or procedure without giving way is what we term endurance. We are straining so hard through the progress in science and technology to seek a remedy for each disease. But you and I agree that this is the battle we haven’t won until now. It is because death is the enemy, we all fight, but in the end, he wins. In the quest for the cure of every disease, health care providers often prescribe medicines and treatment modalities that cause more suffering than that which could have been done by the disease itself. Many patients with no ‘hope’ of cure receive aggressive treatments with side effects that are barely tolerable. A physician must devote the best medical care that carries the least and bearable side effects. A patient should never wish they could be better off dead due to the belligerence of the discourse they are getting. Everyone has a right to die, but no one has a right to fasten the death of another to relieve suffering. However, everybody must die in dignity unless it was abrupt as a tragic accident. Our treatment modalities shouldn’t leave the grieving family members in abject poverty because all the resources were drained by the health care system to look for the cure of an incurable disease say advanced pancreatic cancer. Curing any disease condition shouldn’t inflict more pain to the patient and their family than enduring the disease itself.
Good Lord, deliver us.
In the end, we pray to the Lord to protect us and enable us to be able to have a quality life. When Hutchison prays to God for deliverance, It implies that our health care providers are humans. They should also provide care humanely and compassionately continuously until the end of life. The physician’s prayer coined by one of the eminent physicians in an era when medical care was not advanced as it is today, it holds more water than you can ever imagine. Every medical student who goes to medical school where Hutchison’s clinical methods are the standard clinical methods’ book has read this prayer. But perhaps, they never got a proper understanding of it. Therefore, we decided to revisit it.
Word definitions are from the Oxford Dictionary of English. Download it here.
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