Ideals for the allergist: the importance of teaching in allergy

This article is a distillation of the 2002 Bela Schick lecture, which I had the privilege of presenting at the American College of Allergy, Asthma and Immunology (ACAAI) annual meeting. Although the topic I have chosen is somewhat confusing, few would argue that idealism in one’s career is an important determinate of success. I would like to consider the topic of idealism as a platform to present to you some interesting information on what I believe is a crisis within our specialty. I begin with a little bit of history and then present some data that I obtained with the help of the American Board of Allergy & Immunology and at the American Conference of Graduate Medical Education (ACGME). The definition of an ideal is a standard of perfection, beauty, or excellence. I would not suggest that we seek perfection at all times but rather that we pursue excellence. We don’t have to become ideal allergists, but we have to be allergists who are idealistic or who live with ideals. A recent unattributed quote in a textbook on the value of teaching states that “ideals, like wool liners in overcoats, insulate best when out of sight.” As the quote suggests, perhaps idealism in one’s life is best when it’s transparent. Arguably, the most idealistic and respected physician in modern medicine is Sir William Osler. I had the opportunity of becoming familiar with Osler’s work early in my career as a young medical student. In the early 1970s at the University of Washington, I was fortunate to have as one of my mentors Sir Paul Beeson. He was the only American-born knighted physician and achieved his knighthood through his accomplishments at the Ratcliffe Infirmary at Oxford University. While at Oxford he became friends with Sir William Osler. As a young medical student in the early 1970s when we were mainly concerned with peace, love, and understanding, these history lessons by turn-of-the-century physicians held little interest, but as I got closer to graduation, Sir Paul arranged for me to spend some time at Oxford University, where I worked at the Ratcliffe Infirmary and lived in the Osler Lodge, where I became interested in the life of William Osler. Please indulge a brief history lesson, because I believe it serves as a platform for introducing the topic of teaching in allergy and the importance of allergy and academia. William Osler lived a remarkable life, a life that lasted for 70 years, which in and of itself is remarkable at the turn of the century. Many people don’t know that Sir William Osler was a Canadian, having been born in Ontario after his parents emigrated from England in 1837. He has been described in various ways, but at one point he was called a “small wiry boy with a lively nature who excelled both in academics and in sports.” He studied medicine at the University of Toronto and McGill University, where he became a full professor at the age of 25 years. He was one of the first chairmen of medicine at the University of Pennsylvania in 1884. In 1889, he moved to Johns Hopkins University, where he established the first Division of Internal Medicine, and in 1891 published the landmark Principles and Practice of Medicine,1 a text that Sir Paul Beeson subsequently edited. In 1905, he became the Regis Professor of Medicine at Oxford and was accredited with establishing medical education both in this country and in England. In 1919, he died of an apparent respiratory illness, although most of his friends had attributed his death to the grief he experienced following his son’s death in the Flemish war. He was a remarkable man, who everyone acknowledged was a principled and idealistic physician. A favorite Osler story, which reflects his personality, is one of Sir William and 3 other medical colleagues walking down a blustery, cold, and rainy London street one evening when they encountered a homeless alcoholic who was begging for money. As his colleagues attempted to avoid this homeless man, Sir William turned and gave him his coat and was quoted as saying, “This man may die of alcoholism, but will never die of the exposure to cold.” This was the kind of man he was. In 1905, at the Waldorf-Astoria Hotel in New York City in what some have described as the greatest meeting of American medical giants, his colleagues gathered to honor Dr. Osler’s accomplishments in the United States on the eve of his leaving for Oxford University. On this day, he gave a lecture on the importance of idealism to his colleagues, which included the ideals (1) to do a day’s work well and to not bother about tomorrow, (2) to act the golden rule toward my professional brethren and toward patients committed to my care, and (3) most importantly, to do the kind thing. Everyone who knew Osler remarked that throughout his career his kindness came across to his patients and was a major factor in their well-being. Some had remarked that in fact his kindness Department of Medicine, Division of Allergy and Clinical Immunology, Oregon Health and Sciences University, Portland, Oregon. Received and accepted for publication February 15, 2004.