Ask the DOC

We live in a world dominated by technology where we all spend increasing amounts of time on our cell phones and computers, and less time observing the world around us. As I wrote a few months ago, this includes how medicine is practiced. Many physicians spend more time reviewing lab results and imaging studies than they do observing, listening to, and examining their patients, thereby dulling their senses.

When we think about the art of observation and deductive reasoning, we are reminded of Sir Arthur Conan Doyle’s famous literary character, Sherlock Holmes. Many people do not realize that Doyle was a physician, and that his character Holmes was based on Dr. Joseph Bell, one of Doyle’s professors during his time at the University of Edinburgh. Sir William Osler, known as the father of modern medicine and a contemporary of Bell, also emphasized the importance of observation in his teachings and stated, “The whole art of medicine is in observation … to educate the eye to see, the ear to hear, and the finger to feel.” Or you can distill Dr. Bell’s and Dr. Osler’s wisdom and simply quote Yogi Berra: “You can observe a lot by just watching.”

Arthur Conan Doyle studied medicine at the University of Edinburgh Medical School from 1876 to 1881. It was there that he met Dr. Bell and became his clerk at the Edinburgh Royal Infirmary. Doyle was a moderately successful physician, but his true fame began in 1887 when he created Sherlock Holmes in a novella titled, “A Study in Scarlet.” Doyle would write to Dr. Bell in 1893, “It is most certainly to you that I owe Sherlock Holmes. I do not think his analytical work is in the least an exaggeration of some effects, which I have seen you produce in the outpatient ward.” Dr. Joseph Bell (1837-1911) was a Scottish surgeon. He served as personal surgeon to Queen Victoria whenever she visited Scotland. His diagnostic intuitions astonished medical students and patients alike — even before patients uttered a word. Bell would describe their symptoms and give details of their past lives, rarely making a mistake. While he published several medical textbooks, he was most famous as a teacher – his skill in diagnosis was legendary, and this skill rested substantially on his acute powers of observation.

Bell once told a reporter, “Every good teacher, if he is to make his students good doctors, must get them to cultivate the habit of noticing the little apparent trifles.” In his autobiography Doyle wrote, “I thought of my old teacher Joe Bell, of his eagle face, of his curious ways, of his eerie trick of spotting details. If he were a detective, he would surely reduce this fascinating but unorganized business to something nearer to an exact science.”

It is from the clinical cases of Dr. Bell that we are reminded to spend time observing patients as opposed to the computer. Many diagnoses can be made with a good history and physical examination, thereby eliminating the need to order unnecessary lab and imaging studies. As Bell was fond of saying, “Observe carefully, deduce shrewdly, and confirm with evidence.” Were he alive today, he would no doubt advise not just doctors but everyone to put down the cell phone and computer, and pay attention to what is happening around you.

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