By Richard P. Holm MD
The earliest records of medical teaching came from very ancient Egypt, Babylonia, India, and China. Accounts of experimental and scientific thought, however, first began in Greece and expanded into the medical teaching of Hippocrates and his students. Medical learning then spread to ancient Rome where the word medicine was derived from the Latin “ars medicina,” meaning the art of healing, and this knowledge spread throughout the Roman Empire.
Alas, the ancient knowledge of the Mediterranean would have been lost with the burning of the Library of Alexander and the sacking of Rome except for the collections saved in the Arab world.
Probably the first medical school developed one thousand years ago in the southern Italian coastal city of Salerno. It happened because of a monk named Constantine the African, who understood Arabic and other languages of the time. He could translate, back into Latin, the surviving ancient Grecian and Roman medical texts, which were then written in Arabic and had been invigorated by more than a hundred years of medical practice in Arabia. So it was that in a small library in a Salerno monastery, ancient medical knowledge became accessible once again to the Western world.
Reinvigorated with these translations, the medical practitioners of Salerno became the best care providers of the medieval world, and, in turn, drew the sick in hope of discovering a cure and students seeking to learn the art of medicine. Over time, the sharing and learning accelerated. Salerno thus became known as the “Town of Hippocrates,” where Greek and Latin medical traditions merged with Arab and also Jewish wisdom.
The coming-together of different cultures and information led to a wonderful augmentation and synergy of medical knowledge, where men and women of mixed backgrounds reveled in learning how to care for the sick in a medieval world. Of course this golden time ended by forces of political and cultural hatred, but the knowledge that almost had been lost still survived. Some of it is taught in medical schools today.
May we always remember the lessons of the past, the value of recording knowledge, and the wisdom of sharing cultures.
Sunday, September 19, 2010
Thursday, July 29, 2010
The Hippocratic Promise
Richard P. Holm MD
Through ancient and modern history, there is a tradition in the medical profession that the graduating medical student publicly and formally takes an oath and promises to uphold high ethical standards. It is a med student rite of passage, which has been handed down from our ancestors.
Historically it has been the Hippocratic oath, which is to swear by Apollo the Physician, and Asclepius and Hygieia and Panaceia and all the gods, and goddesses, to preserve life and to care for all regardless of rank, age or intellect. This apparently represented a shift in attitude in ancient Greece, as earlier many had used the knowledge of medicines and herbs to poison. Also it asked that the life of a slave, the life of the Emperor, the life of a foreign man, and the life of a child with a disability should all be valued as equal in importance.
But this traditional oath is replete with modern controversy. For example if the old oath is followed, the children of physicians would have preferential admission into medical school; we could not cut out kidney or bladder stones, or do any surgery for that matter; physicians could not take payment for providing care to patients (except maybe room and board); and there would be conflict with how we presently give suffering terminal patients enough pain medicine. Indeed, the old oath was meant for another time.
At the Sanford USD School of Medicine as in every medical school graduating medical students still give a contemporary version of the Hippocratic oath. Although there is some variation between schools, every version promises to diminish suffering and enhance health; to do no harm; to search for truth through science; and to respect the freedom and right of self direction for every patient. Modern versions also speak to just distribution of care when resources are limited, avoiding over and under-treatment, asking for help when necessary, and the art of a warm, sympathetic, and caring bedside manner.
Every physician upon entering the medical profession has made an oath and covenant to uphold a worthy ethical standard. This is more than tradition. It is a promise.
Through ancient and modern history, there is a tradition in the medical profession that the graduating medical student publicly and formally takes an oath and promises to uphold high ethical standards. It is a med student rite of passage, which has been handed down from our ancestors.
Historically it has been the Hippocratic oath, which is to swear by Apollo the Physician, and Asclepius and Hygieia and Panaceia and all the gods, and goddesses, to preserve life and to care for all regardless of rank, age or intellect. This apparently represented a shift in attitude in ancient Greece, as earlier many had used the knowledge of medicines and herbs to poison. Also it asked that the life of a slave, the life of the Emperor, the life of a foreign man, and the life of a child with a disability should all be valued as equal in importance.
But this traditional oath is replete with modern controversy. For example if the old oath is followed, the children of physicians would have preferential admission into medical school; we could not cut out kidney or bladder stones, or do any surgery for that matter; physicians could not take payment for providing care to patients (except maybe room and board); and there would be conflict with how we presently give suffering terminal patients enough pain medicine. Indeed, the old oath was meant for another time.
At the Sanford USD School of Medicine as in every medical school graduating medical students still give a contemporary version of the Hippocratic oath. Although there is some variation between schools, every version promises to diminish suffering and enhance health; to do no harm; to search for truth through science; and to respect the freedom and right of self direction for every patient. Modern versions also speak to just distribution of care when resources are limited, avoiding over and under-treatment, asking for help when necessary, and the art of a warm, sympathetic, and caring bedside manner.
Every physician upon entering the medical profession has made an oath and covenant to uphold a worthy ethical standard. This is more than tradition. It is a promise.
Tuesday, July 13, 2010
Valuing Others
By Richard P. Holm MD
This week, in our little town in South Dakota, a young man in his twenties came into my office weeping and scratching his arms and legs. I was expecting a rash-type problem, when he blurted out that he was injecting methamphetamine two to four times a day. “It has destroyed my life,” he said. “I used to have a job, insurance, a house, and a life. Now I have nothing. Please help me,” he cried. I did my best for him.
By definition addiction is the state of physical or psychological dependence on a drug, which is liable to have a damaging effect. It’s a habit, a compulsion, or an obsession, which turns around and bites the user and everyone nearby. Alcoholism is the most pervasive and obvious addiction in our society. If it doesn’t directly affect you, most certainly it affects someone dear to you.
The potential for addiction is part of our collective human nature. I dare say that every one of us given just the right situation would be addicted to one drug or another, whether it be cigarettes, pain medicines, sleeping pills, marijuana, methamphetamine or a fine red wine.
What is it that separates the addict from normal happy people who are able to function in society? Some experts define addiction and, specifically, alcoholism with the four features of craving, loss of control, physical dependence, and tolerance. Others add that addiction means losing perspective about what has value in life. Vision of the surrounding world dims, and instead the addict obsesses on self and how to get another shot, pill, snort, drag, or drink. Addiction accelerates like a maelstrom into such selfness until nothing else exists.
It makes sense then that the opportunity for recovery comes with the sacred message of the Golden Rule: treating others with compassion and fairness. Valuing others is the key ingredient in order to sober- up the self-absorbed addicted individual. It is no wonder spiritual based programs for sobriety are the most successful.
No question, we are all at risk for the selfish cycle of addiction, and our best help comes by relearning how to care for others.
This week, in our little town in South Dakota, a young man in his twenties came into my office weeping and scratching his arms and legs. I was expecting a rash-type problem, when he blurted out that he was injecting methamphetamine two to four times a day. “It has destroyed my life,” he said. “I used to have a job, insurance, a house, and a life. Now I have nothing. Please help me,” he cried. I did my best for him.
By definition addiction is the state of physical or psychological dependence on a drug, which is liable to have a damaging effect. It’s a habit, a compulsion, or an obsession, which turns around and bites the user and everyone nearby. Alcoholism is the most pervasive and obvious addiction in our society. If it doesn’t directly affect you, most certainly it affects someone dear to you.
The potential for addiction is part of our collective human nature. I dare say that every one of us given just the right situation would be addicted to one drug or another, whether it be cigarettes, pain medicines, sleeping pills, marijuana, methamphetamine or a fine red wine.
What is it that separates the addict from normal happy people who are able to function in society? Some experts define addiction and, specifically, alcoholism with the four features of craving, loss of control, physical dependence, and tolerance. Others add that addiction means losing perspective about what has value in life. Vision of the surrounding world dims, and instead the addict obsesses on self and how to get another shot, pill, snort, drag, or drink. Addiction accelerates like a maelstrom into such selfness until nothing else exists.
It makes sense then that the opportunity for recovery comes with the sacred message of the Golden Rule: treating others with compassion and fairness. Valuing others is the key ingredient in order to sober- up the self-absorbed addicted individual. It is no wonder spiritual based programs for sobriety are the most successful.
No question, we are all at risk for the selfish cycle of addiction, and our best help comes by relearning how to care for others.
Friday, June 18, 2010
Protecting Little Girls
By Richard P. Holm MD
Lying on the rolling cot in the emergency room, the beautiful six-year-old little girl was unconscious with bruises on her head, face, and scattered over her body. “Please help her,” pleaded the woman with a baby in her arms. She told me the little girl had been trying to learn how to ride the bike her Daddy had just purchased for her, and I believed what the woman told me.
After the bleed into the brain was diagnosed the story unfolded, and I learned that the woman was not the mother of the injured girl, rather the girlfriend of the father and that the overwhelming evidence showed the physical abuse came from the girlfriend. No one had been there to protect that little girl, and she died a day later from severe head trauma.
Child abuse is only one kind of violence, which can occur between members of any group of people living together. The American Psychiatric Association defines domestic violence as control by one family member over another with some kind of physical, sexual, emotional and/or economic abuse. It comes down to an issue of power, where someone with the upper hand takes advantage of another.
The Centers for Disease Control states that we know about only one third of the cases, and estimates that domestic violence affects more than 32 million Americans, or over ten percent of the U.S. population.
Why does this happen? Is it because our human nature wants to put someone else down when feeling inadequate or angry with our self? Is it because children who are raised in a home where it is not safe learn to threaten and bully rather than to protect people close to them, and this kind of activity perpetuates itself?
No one should have to live in a home where someone with an upper hand abuses another person, a spouse, a partner, a child, or even an elderly parent. Our job in this family of humanity is to find ways to protect little girls and everyone else from those who are threatening abuse.
Lying on the rolling cot in the emergency room, the beautiful six-year-old little girl was unconscious with bruises on her head, face, and scattered over her body. “Please help her,” pleaded the woman with a baby in her arms. She told me the little girl had been trying to learn how to ride the bike her Daddy had just purchased for her, and I believed what the woman told me.
After the bleed into the brain was diagnosed the story unfolded, and I learned that the woman was not the mother of the injured girl, rather the girlfriend of the father and that the overwhelming evidence showed the physical abuse came from the girlfriend. No one had been there to protect that little girl, and she died a day later from severe head trauma.
Child abuse is only one kind of violence, which can occur between members of any group of people living together. The American Psychiatric Association defines domestic violence as control by one family member over another with some kind of physical, sexual, emotional and/or economic abuse. It comes down to an issue of power, where someone with the upper hand takes advantage of another.
The Centers for Disease Control states that we know about only one third of the cases, and estimates that domestic violence affects more than 32 million Americans, or over ten percent of the U.S. population.
Why does this happen? Is it because our human nature wants to put someone else down when feeling inadequate or angry with our self? Is it because children who are raised in a home where it is not safe learn to threaten and bully rather than to protect people close to them, and this kind of activity perpetuates itself?
No one should have to live in a home where someone with an upper hand abuses another person, a spouse, a partner, a child, or even an elderly parent. Our job in this family of humanity is to find ways to protect little girls and everyone else from those who are threatening abuse.
Wednesday, May 19, 2010
Slow Food
By Richard P. Holm
Why does food satisfy the appetite? If we could understand what tells us when to stop eating, then maybe we could understand the cause for obesity.
We know that a hormone called ghrelin delivers feelings of hunger to the brain and that two hormones called cholecystokinin and leptin bring feelings of satiation. So far, however, scientists, and especially those of the pharmaceutical industry, have failed in efforts to safely manipulate these natural signals to stimulate or suppress hunger.
Another direction of research comes with understanding how certain foods like oatmeal, boiled potatoes, or fresh fruit fill you up, and others like donuts, French fries, or even dried fruit do not. It is interesting to note that drinks of any kind seem very poor in providing feelings of fullness or satiety. It makes perfect sense then that if one is struggling with obesity, foods that do not satisfy hunger, especially those that are highly caloric, should be avoided.
And what about eating too fast? We know it takes time for the food we eat to stimulate our satiety hormones. We all know it is not very satisfying when we shove fast food into our mouths and swallow it down with a big gulp. No one can argue that the obesity epidemic could be related to oh-so-convenient fast food, which seems to match the fast-paced, unsatisfying rush of modern life.
In contrast, there is the Slow Food movement founded in Italy in the 1980s. Slow Food asks us to preserve regional cuisine and local flavors, and to promote local gardens and local family farmers. Slow Food asks us to shop the farmer’s markets, raise our own gardens, teach our children to cook, take time around the supper table to eat slowly, savor the food, and enjoy the company of family.
Bottom line, and the pun is intended: all the rush, with our busy frenetic modern lives, and especially with all that fast-fast food, has left us weighing more and satisfied less. It is time to slow down and savor our food and our lives. to slow down.
Why does food satisfy the appetite? If we could understand what tells us when to stop eating, then maybe we could understand the cause for obesity.
We know that a hormone called ghrelin delivers feelings of hunger to the brain and that two hormones called cholecystokinin and leptin bring feelings of satiation. So far, however, scientists, and especially those of the pharmaceutical industry, have failed in efforts to safely manipulate these natural signals to stimulate or suppress hunger.
Another direction of research comes with understanding how certain foods like oatmeal, boiled potatoes, or fresh fruit fill you up, and others like donuts, French fries, or even dried fruit do not. It is interesting to note that drinks of any kind seem very poor in providing feelings of fullness or satiety. It makes perfect sense then that if one is struggling with obesity, foods that do not satisfy hunger, especially those that are highly caloric, should be avoided.
And what about eating too fast? We know it takes time for the food we eat to stimulate our satiety hormones. We all know it is not very satisfying when we shove fast food into our mouths and swallow it down with a big gulp. No one can argue that the obesity epidemic could be related to oh-so-convenient fast food, which seems to match the fast-paced, unsatisfying rush of modern life.
In contrast, there is the Slow Food movement founded in Italy in the 1980s. Slow Food asks us to preserve regional cuisine and local flavors, and to promote local gardens and local family farmers. Slow Food asks us to shop the farmer’s markets, raise our own gardens, teach our children to cook, take time around the supper table to eat slowly, savor the food, and enjoy the company of family.
Bottom line, and the pun is intended: all the rush, with our busy frenetic modern lives, and especially with all that fast-fast food, has left us weighing more and satisfied less. It is time to slow down and savor our food and our lives. to slow down.
When Grandma Wants to Pull the Plug
By Richard P. Holm MD
“We will all be dead one day, we should not pretend that it won’t happen, and we should all prepare for the experience rather than ignore it.” Recently I was asked to give a talk about the value of the Living Will, and I remember that it became very quiet after those words.
I spoke to a room full of mostly retired people, some of them quite elderly, and I explained that, too often, I have watched helplessly while desperate, fruitless, excessive, and painful health care was provided to a person certainly dying. Put it down as one more paradox in medicine. The fear of death and not facing the reality of dying can be responsible for much of the suffering that can occur at the end of life.
A Living Will, also called an Advanced Directive, is simply a tool to communicate about how you would like to die. It is not about a legal document, it is all about talking to your family. We know there is a time to intervene with fancy medical care and there is a time to let go. My final talking point: the Living Will makes it easier for families to allow a natural and comfortable death when the time is right.
After the presentation one guy told me his wife purposefully avoided coming because she didn’t want to think about such gloomy things. He said wryly, “We are all going to die. Why shouldn’t we talk about it?”
Another asked, “I still don’t know the definition of a Living Will. Does it have anything to do with death squads pulling the plug on Grandma?” I responded, “No, just the opposite. It is all about Grandma telling us when not to put tubes in, so no one has to pull a plug.”
I can’t say it was my happiest audience, and I’m afraid I may have offended some of them by being so blunt. But in this age of external chest massage, shocking paddles, breathing machines, feeding tubes, and the potential for years of vegetative bedridden life, there is hardly a more important message.
“We will all be dead one day, we should not pretend that it won’t happen, and we should all prepare for the experience rather than ignore it.” Recently I was asked to give a talk about the value of the Living Will, and I remember that it became very quiet after those words.
I spoke to a room full of mostly retired people, some of them quite elderly, and I explained that, too often, I have watched helplessly while desperate, fruitless, excessive, and painful health care was provided to a person certainly dying. Put it down as one more paradox in medicine. The fear of death and not facing the reality of dying can be responsible for much of the suffering that can occur at the end of life.
A Living Will, also called an Advanced Directive, is simply a tool to communicate about how you would like to die. It is not about a legal document, it is all about talking to your family. We know there is a time to intervene with fancy medical care and there is a time to let go. My final talking point: the Living Will makes it easier for families to allow a natural and comfortable death when the time is right.
After the presentation one guy told me his wife purposefully avoided coming because she didn’t want to think about such gloomy things. He said wryly, “We are all going to die. Why shouldn’t we talk about it?”
Another asked, “I still don’t know the definition of a Living Will. Does it have anything to do with death squads pulling the plug on Grandma?” I responded, “No, just the opposite. It is all about Grandma telling us when not to put tubes in, so no one has to pull a plug.”
I can’t say it was my happiest audience, and I’m afraid I may have offended some of them by being so blunt. But in this age of external chest massage, shocking paddles, breathing machines, feeding tubes, and the potential for years of vegetative bedridden life, there is hardly a more important message.
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