[Editor's Note: As promised in the mission statement of this blog we strive to bring our readers the brightest and the best in contemporary medical writing. Our latest entry (and painstakingly researched we might add) is the first of a series about the history of the healing arts.]
1889: Dr. William Osler, Chairman of Clinical Medicine at the University of Pennsylvania, leaves Philadelphia to become Physician-in-Chief at the newly created Johns Hopkins Hospital in Baltimore, Maryland. Regarded as the 'Father of Modern Medicine' and one of the greatest teachers of all time, Osler quickly moves the novice medical students out of the lecture hall and in into the wards, where he establishes new concepts such as the residency program and bedside teaching. With his insistence on exposing students to actual patients, combined with his rigorous style of teaching, he not only brought medical education from the middle ages to the modern era, but inspired young doctors to contrive several time-honored traditions, such as faking patient vital signs during morning rounds. It was the fear of Sir William's critical gaze that led interns to create what is now called the "V. A. neuro test," which consists of asking the veteran to take a urine cup, go into the bathroom and bring back a specimen. If he does this without spilling, the results of the neurological exam are recorded as "W.N.L.," which stands for either "within normal limits" or "we never looked."
Other tactics supposedly inspired by the Great Teacher include sleeping while standing up, eating bacon from a patient's tray (with or without creating a diversion), prefacing all answers with the phrase "Well that depends...", and finding a heart murmur in every living being including members of the cervine family. We salute this giant of medicine and give our grateful thanks to his genius and diligence. Now go work up that new admission and don't wake me until 7 A.M.!
I feel somehow wronged in my medical education that I just now have learned of the VA neuro test. Curse you, University of Michigan!
I love finding out that medicine the world over is the same; I trained in South Africa and can easily relate to the intern tactics.
One favourite notation on rounds is 'Neuro/Abdo/Genitourinray exam NAD'; NAD standing for 'No Abnormalities Detected' or more appropriately 'Not Actually Done'
You also cannot understand the history of the Great Influenza of 1918 without knowing about Osler.