If you’re like most fans of the Center for Innovative Medicine, you’ve got a recurring event on your calendar you aim not to miss: the CIM Seminars, which unfold on Tuesday afternoons at 4 p.m. via Zoom. Each session features a keynote speaker invited by CIM Director David Hellmann to share highlights of his or her current work on fascinating topics ranging from humanities in medicine to artificial intelligence and early detection of cancer.
This academic year, Hellmann invited the newest CIM Scholar, Johns Hopkins cardiologist Thomas Traill, to act as a co-planner for the CIM Seminars. A professor of medicine, Traill is former associate director of the Osler Medical Housestaff Training Program for residents.
“Tom is a brilliant and thoughtful cardiologist with deep interest and knowledge of the history of medicine,” says Hellmann. “I’m thrilled that he will be planning and hosting about half of the year’s seminars, focusing on the important theme of healing.”
In the Q&A that follows, Traill talks about his vision for the CIM Seminars and, more broadly, why it’s so important in today’s health care milieu not to lose sight of the human side of medicine.
Could you share a bit about your thematic vision for the seminars you planned — and how that ties into CIM’s ongoing mission to humanize medicine?
Like CIM, I wholeheartedly subscribe to the importance of keeping medicine humanized. I also believe there are pressures that increasingly threaten that intent.
In this early 21st century, we are living in the era of molecular medicine. We read every day about the discovery of a new disease-causing molecule and the therapeutic molecule that’s going to fix it. Molecular medicine allows for extraordinary precision, stuff that would have been unbelievable even a few years ago.
“Like CIM, I wholeheartedly subscribe to the importance of keeping medicine humanized. I also believe there are pressures that increasingly threaten that intent.” – Thomas Traill
But as physicians, it’s forced us to move to a different level of looking at human beings, a different scale. We are looking at molecules, not organs. We are looking at molecular physiology and no longer at how the body works as a whole, how whole organs fail. This is a huge shift in the ground for all disciplines of medicine. And I believe it comes at a cost to understanding and explaining to our patients, to our ability to heal people, and to medical education.
Along those lines, the first of the talks I organized was given in September by Johns Hopkins psychologist Kay Redfield Jamison, who also happens to be my wife. She focused on the “wounded healer,” which is a theme of her newest book, Fires in the Dark: Healing the Unquiet Mind. Her book explores how psychotherapy and medicine, as well as rituals, nature, religion, love and music, can all be crucial to healing. One healer Kay focuses on is Sir William Osler, who lost his beloved son, Revere, in World War I. The elder Osler’s own grief and suffering shaped his ability to bring healing to others.
You’ll also be bringing in the voices of some speakers from outside of medicine?
Yes, I’ve invited two people to speak in December who are episcopal priests. Stuart Kenworthy and David Peters have served on the front lines as Army chaplains in Iraq. They have extraordinary stories to tell about caring for people who have experienced physical trauma and moral injury: both injured soldiers and also themselves.
On a slightly more light-hearted note, you also gave a talk that looks at how doctors are perceived by the public based on how they are portrayed in fiction and on the screen.
If you watch just a few minutes of an episode of the iconic TV series Marcus Welby, M.D., which starred Robert Young and aired from 1969 to 1976, you’ll find him talking about what gets him up in the morning and his affection for being a “real doctor.”
Around the same time, there was Dr. Finlay’s Casebook, the BBC series that ran from 1962 to 1971, based on the books of A.J. Cronin. Dr. Finlay was a stalwart of general practice. He comes home from World War II as a young, psychologically wounded practitioner and then devotes himself to serving patients through the newly established National Health Service.
Then, put them both up against actor Hugh Laurie, the titular star of the TV show House [which ran on Fox from 2004 to 2012]. House is a very interesting character. In the very first episode, he comes up with remarks like, “Everybody lies,” and “Humanity is overrated.” Then he pulls a diagnosis out of the air without ever seeing the patient. Other times, there are allusions to Sherlock Holmes, who would astonish people by recognizing who they were and where they’d been before they had even opened their mouths — another complicated man.
The evolution from Marcus Welby and John Finlay through to the brilliant misanthropic House sheds an interesting light on how the public sees us and how young people see the profession that they are about to enter. In interviews I’ve done with residency applicants, several have said they were impressed with House and wanted to be like House, at least in his positive aspects.
You have other speakers?
Yes. Karen Swartz in psychiatry and Duke Cameron in cardiac surgery, both people I have known for much of my career at Johns Hopkins and whom I admire enormously for their care of patients. Karen will be speaking about the intersection between psychiatry and public health in recognizing depression in school-age children. Duke will speak to the complex relationships we have with medical technology — the good and the not so good.
That offers a nice segue into your thoughts about the state of bedside teaching of physician trainees.
Going all the way back to William Osler, he felt passionately that people who teach medicine should be the people who are doing medicine. What was true then is even more true now. I worry that bedside teaching by the great clinicians — the Philip Tumultys of the world — is really threatened, as precision medicine and expert guidelines start to dominate hospital practice and as diagnostic workups are increasingly taking place in the Emergency Department. The days of someone like Osler sitting at a patient’s bedside in the wards and scratching their chin over a diagnosis are mostly gone.
“The Johns Hopkins of the future should be a place where young doctors in training can see today’s generation of Oslers scratching their chins — but this will probably need to take place in the outpatient clinic, not by the bedside in the hospital.” – Thomas Traill
The Johns Hopkins of the future should be a place where young doctors in training can see today’s generation of Oslers scratching their chins — but this will probably need to take place in the outpatient clinic, not by the bedside in the hospital. It’s in the outpatient clinics where most of today’s patients are coming in undiagnosed and in need of human help.
