Patients--a virtue?

TODAY it is my privilege to address you on behalf of my colleagues on the medical staff of the Royal. The giving of an oration, as it is now called, at the beginning of the winter term, is sanctified by a tradition extending backward in time for more than 150 years. It is customary to welcome, in particular, those of you who have recently begun their clinical studies, and this I do with great pleasure. The choice of orator is not made by election, nor by selection, but by direction on the basis of sequential seniority. Seniority, the word itself, has an ominous ring for the young, indicating, as it may occasionally do, survival rather than achievement, a state sustained by the aphorisms and inexactitudes of the past. In medicine, as in other aspects of life, the gap between generations is wide, and widening; the giving of advice across this divide, except in the most general terms, is not always useful, and is seldom tolerated. Perhaps Lord Chesterfield had this in mind when, in a letter to his son he wrote; "Surely it is of great use to a young man, before he set out for that country full of mazes, windings, and turnings, to have at least a general map of it, made by some experienced traveller". One may say, then, and slightly to misquote WB Yeats; "This is no country for old men', and it is therefore gratifying to see so many, even too many, young men and women ready, willing, and certainly able to undertake this journey, or pilgrimage, for such it is. For this endeavour, each of you is endowed with different talents, none of which is too humble to be of value in the exercise of your chosen profession, nor too exalted to be beyond its requirements. It is the function of your teachers to help you to recognise and develop these talents, in the relatively short time which remains to you as undergraduates. Much of this time will be spent in this hospital, and in that part of the medical school associated with it. In discussing the relationship between these institutions Osler, writing in 1892, emphasised the "necessity of ample, full and prolonged clinical instruction, and the importance of bringing the student and patient into close contact, not through the cloudly knowledge of the amphitheatre, but by means of the accurate, critical knowledge of …