Published on July 22, 2013
From Hippocrates toFrom Hippocrates to Osler to FOAMOsler to FOAM Joe Lex, MD, FACEP, MAAEMJoe Lex, MD, FACEP, MAAEM Department of Emergency MedicineDepartment of Emergency Medicine Temple University School of MedicineTemple University School of Medicine Philadelphia, PA USAPhiladelphia, PA USA firstname.lastname@example.org @JoeLex5joe@joelex.net @JoeLex5
No CommercialNo Commercial Interests to DeclareInterests to Declare
460 – 370 BC460 – 370 BC
HippocratesHippocrates • Trained at the asklepieion of KosTrained at the asklepieion of Kos • Took lessons from Thracian physicianTook lessons from Thracian physician Herodicus of SelymbriaHerodicus of Selymbria • InIn PhaedrusPhaedrus, Plato says “Hippocrates, Plato says “Hippocrates the Asclepiad” thought that athe Asclepiad” thought that a complete knowledge of the nature ofcomplete knowledge of the nature of the body was necessary for medicinethe body was necessary for medicine
Hippocratic OathHippocratic Oath To hold him who has taught me this artTo hold him who has taught me this art as equal to my parents and to live myas equal to my parents and to live my life in partnership with him …and tolife in partnership with him …and to regard his offspring as equal to myregard his offspring as equal to my brothers … and tobrothers … and to teach them this artteach them this art – if they desire to learn it –– if they desire to learn it – without feewithout fee and covenant…and covenant…
980? – 1037980? – 1037
Abū ‘Alī al-Abū ‘Alī al- usayn ibnḤusayn ibnḤ ‘Abd Allāh‘Abd Allāh ibn Sīnā –ibn Sīnā – AKAAKA سينا پورسينا پور,, AvicennaAvicenna
AvicennaAvicenna • Most famous Persian physicianMost famous Persian physician • Also wrote on philosophy, astronomy,Also wrote on philosophy, astronomy, alchemy, geology, psychology, logic,alchemy, geology, psychology, logic, Islamic theology, mathematics, andIslamic theology, mathematics, and physicsphysics • And he wrote poetryAnd he wrote poetry • Sort of like Leonardo de VinciSort of like Leonardo de Vinci
Avicenna on EducationAvicenna on Education • Education must prepare someone forEducation must prepare someone for a profession whereby he cana profession whereby he can contribute to the social structurecontribute to the social structure • Society is built entirely on cooperationSociety is built entirely on cooperation and specialization of each individualand specialization of each individual • In other words, get along with yourIn other words, get along with your consultantsconsultants
Avicenna on EducationAvicenna on Education If the teacher transmitsIf the teacher transmits knowledge with care andknowledge with care and feeling, then the student willfeeling, then the student will copy his manners and hiscopy his manners and his virtues, effortlessly and withoutvirtues, effortlessly and without realizing it, in the process ofrealizing it, in the process of “learning by imitation”“learning by imitation”
Edgar A. Guest in 1920sEdgar A. Guest in 1920s And the lecture you deliver may be veryAnd the lecture you deliver may be very wise and true,wise and true, But I’d rather get my lessons byBut I’d rather get my lessons by observing what you do;observing what you do; For I might misunderstand you and theFor I might misunderstand you and the high advice you give,high advice you give, But there’s no misunderstanding howBut there’s no misunderstanding how you act and how you live.you act and how you live.
1493 – 15411493 – 1541
ParacelsusParacelsus • TheophrastusTheophrastus Phillippus AureolusPhillippus Aureolus Bombastus vonBombastus von HohenheimHohenheim • Contemporary ofContemporary of Martin Luther,Martin Luther, Copernicus, daCopernicus, da VinciVinci
ParacelsusParacelsus ““No man becomes master whileNo man becomes master while he stays at home, nor finds ahe stays at home, nor finds a teacher behind the stove.teacher behind the stove. Diseases wander here andDiseases wander here and there the whole length of thethere the whole length of the world. He who wouldworld. He who would understand them must wander.”understand them must wander.”
ParacelsusParacelsus ““He stands like a tree with spreadingHe stands like a tree with spreading branches, and with each year thatbranches, and with each year that passes the leaves he puts forth seempasses the leaves he puts forth seem richer and greener. Always andricher and greener. Always and everywhere living and active in hiseverywhere living and active in his power to fructify our souls, he is stillpower to fructify our souls, he is still living among us today.”living among us today.” - Jolande Szekacs Jacobi- Jolande Szekacs Jacobi
1514 – 15641514 – 1564
Andreas VesaliusAndreas Vesalius 31 Dec 1514 – 15 Oct 156431 Dec 1514 – 15 Oct 1564
Andreas VesaliusAndreas Vesalius • Customary anatomy teaching: sit inCustomary anatomy teaching: sit in an elevated chair, read from a text ofan elevated chair, read from a text of Galen and watch while an unskilledGalen and watch while an unskilled barber-surgeon conducted thebarber-surgeon conducted the dissectiondissection • Vesalius descended from the chair,Vesalius descended from the chair, handled body, dissected organshandled body, dissected organs
1668 – 17381668 – 1738
Baron Jan Gerrit vanBaron Jan Gerrit van Wassenaer heer vanWassenaer heer van Rosenberg, PrefectRosenberg, Prefect of Rhineland andof Rhineland and Grand Admiral of theGrand Admiral of the Dutch FleetDutch Fleet
Baron Jan Gerrit van WassenaerBaron Jan Gerrit van Wassenaer
Herman BoerhaaveHerman Boerhaave • Dutch botanist, humanist, physicianDutch botanist, humanist, physician • Founder of clinical teaching and ofFounder of clinical teaching and of modern academic hospitalmodern academic hospital • Demonstrated relation of symptomsDemonstrated relation of symptoms to lesionsto lesions • His motto:His motto: Simplex sigillum veriSimplex sigillum veri (Simplicity is the sign of truth.)(Simplicity is the sign of truth.)
Occam’s RazorOccam’s Razor • Entia non sunt multiplicanda praeterEntia non sunt multiplicanda praeter necessitatemnecessitatem • Lex parsimoniae: aLex parsimoniae: among competingmong competing hypotheses, the one that makes thehypotheses, the one that makes the fewest assumptions should befewest assumptions should be selectedselected
1825 – 18931825 – 1893
CharcotCharcot ReplacedReplaced traditionaltraditional hospital roundshospital rounds at Salpêtrièreat Salpêtrière with clinicalwith clinical demonstrationsdemonstrations and patientand patient interviews ininterviews in the hospital…the hospital…
CharcotCharcot ……completecomplete with curtains,with curtains, lighting, etc…lighting, etc… ……and heand he opened themopened them to the public.to the public.
Jean-Martin CharcotJean-Martin Charcot • By the way, that’sBy the way, that’s Joseph BabinskiJoseph Babinski supporting thesupporting the patientpatient • Other students:Other students: Sigmund Freud,Sigmund Freud, Gilles de la TouretteGilles de la Tourette
1849 – 19191849 – 1919
Osler on TeachingOsler on Teaching ““Observe, record, tabulate,Observe, record, tabulate, communicate. Use your fivecommunicate. Use your five senses. Learn to see, learn tosenses. Learn to see, learn to hear, learn to feel, learn tohear, learn to feel, learn to smell, and know that bysmell, and know that by practice alone you canpractice alone you can become expert.”become expert.”
Osler on TeachingOsler on Teaching ““I desire no other epitaph…thanI desire no other epitaph…than the statement that I taughtthe statement that I taught medical students in the wards,medical students in the wards, as I regard this as by far theas I regard this as by far the most useful and important workmost useful and important work I have been called upon to do.”I have been called upon to do.”
Osler on TeachingOsler on Teaching ““No bubble is soNo bubble is so iridescent or floatsiridescent or floats longer than that blownlonger than that blown by the successfulby the successful teacher.”teacher.”
1982 – 19861982 – 1986
UTHSC @ San AntonioUTHSC @ San Antonio
UTHSC @ San AntonioUTHSC @ San Antonio I was 34 years old…I was 34 years old… ……without a college degreewithout a college degree ……but with 4 years as an Army medicbut with 4 years as an Army medic ……and 4 years as an ER techand 4 years as an ER tech ……and 3 years as an ER nurseand 3 years as an ER nurse ……and they took a chanceand they took a chance But Why FOAM?But Why FOAM?
UTHSC @ San AntonioUTHSC @ San Antonio My tuition for the first two years was…My tuition for the first two years was… USD$300 / yearUSD$300 / year It went up to $1200 / yearIt went up to $1200 / year by the time I graduatedby the time I graduated
2000 – present2000 – present
American Academy ofAmerican Academy of Emergency MedicineEmergency Medicine
American Academy ofAmerican Academy of Emergency MedicineEmergency Medicine • ~5000 members~5000 members • Membership USD$425 / yearMembership USD$425 / year • Annual Scientific Assembly: FREE toAnnual Scientific Assembly: FREE to membersmembers
2010 – present2010 – present
Calcification Inhibitors in CKD and Dialysis Patients
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