Clinical Study and Laboratory Methods.
I am continually arguing in favor of clinical teaching in all colleges. Clinical instruction is the essential, the practical, the basic method in my mind, for the medical student. The laboratory methods of the leading colleges are highly scientific and have their place, but they should not exclude clinical methods. A writer in the Lancet Clinic, while favoring laboratory methods, makes some very sensible statements concerning them, and in favor of practical, clinical observation. He says:
It is not so necessary for a physician to be able to make the test for arsenic in the gastric contents in a suspected case of poisoning, as to be thoroughly conversant with the symptoms, to estimate the exact per cent of polynuclear leucocytes in a case of suppuration as it is to know the really more reliable clinical symptoms of such a condition. The combination would be nearly ideal, but other circumstances—and there are many—govern our careers.
Grant the average young physician a good laboratory training. He, as a rule, at the outset finds himself poorly equipped to carry on the work in the thorough manner required. He has the time but little opportunity is afforded him. from his all too limited clientele, to exercise his knowledge. Patronage from older practitioners is not of sufficient frequency or regularity to keep the work going constantly. The result is that any special adaptability he may have had declines for want of practice. His reports become of decreasing value or possibly misleading, thereby bringing a most valuable adjunct to medical diagnosis—and possibly himself—into disrepute.
Too much laboratory instruction, especially when practical methods have been neglected or considered of secondary importance, destroys in a great measure clinical confidence and sell-reliance. There is a prevailing tendency to view the world through the small aperture of a microscope, to see a little, great, and the great, but little. The laboratory doctor—and there are such —rushes to his microscope and reagents, gets their reports—often unreliable, as we have seen, before he ventures an opinion, and then, more frequently than not, places the responsibility of the final decision upon the practical diagnostician.
The five senses with which we all are endowed serve us better collectively, especially when trained a little, than any acquired sixth or laboratory sense. Laboratory sense should always be considered, for it is a positive value, but should never be given preference. It is a valuable adjunct, an adjunct only, to medical instruction as well as to medical practice. All too frequently, problems present themselves which with all our acumen, with all our senses, sixth included, remain problems still, and will, until some one, perhaps a laboratory man, comes to our assistance.
Laboratories are, but should not be, given preference to clinical and practical training in general college work.
More attention should be given to direct clinical and practical instruction.
The establishment of clinical laboratories conducted by experts, should be encouraged.