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Commentary
Revised

A letter to the Master Clinician

[version 2; peer review: 2 approved]
PUBLISHED 13 Feb 2014
Author details Author details
OPEN PEER REVIEW
REVIEWER STATUS

Abstract

In this commentary, the author writes a letter to the Master Clinician about his concerns regarding the teaching responsibilities of current faculty members during ward rounds. This short essay highlights the transition that has been noticed in medical training in the last decade.

Revised Amendments from Version 1

Thank you to the two reviewers for their comments. Some of the changes are now revised in the new version. Some changes will disrupt the flow of the letter and hence were not made. 

To read any peer review reports and author responses for this article, follow the "read" links in the Open Peer Review table.

Dear Master Clinician,

Re: Invitation

I am writing this letter to ask you to please return to us. In your absence, we have felt your loss.

Today, when I walk down the halls of my academic hospital, I feel an emptiness. The constant flow of work onto the secretary’s desk begins at 7 am. The transporter brings a patient back from the ultrasound room. The residents hurry to gather data from the chart before their attending arrives. The nurses scurry to change shifts. These long halls are busy with secretaries working hard, nurses doing their jobs, and nurse practitioners and physician assistants writing notes on the chart. In the midst of all this busy life for our residents, fellows and medical students, there is something now missing.

As a consultant on the floor, I see a crowd of physicians making their rounds. The medical students are easily recognizable by their short white coats. Then I stop, I see someone presenting data: Ahhh! that must be the intern. There are residents discussing patients with a hospitalist. The endocrine consultant team walks onto the floor, and the cycle starts all over again. I have noticed in the last few years that the physician-in-charge is usually inexperienced, and probably has just 1–3 years more experience than the third year resident. What has changed? What is missing? Few now stay on to continue to build their experience but rather join a fellowship program or outpatient practice. Soon, they are replaced by new fresh group of them just graduating from residency. Have we lost the Master Clinician?

The people who inspired us to become who we are today were the great Master Clinicians of their time and they shared with us their wisdom, knowledge and wealth of experience. It would be wrong to say that we are losing the art of physical exam and diagnosis, but rather that we have lost the art. You shared your wisdom with the team and taught the fellows and residents not only bedside manners, but also told us about your experiences. Now you have been replaced with inexperienced faculty, textbooks have been replaced by Google and stethoscopes have been replaced by handheld devices.

Where have you been? Now you only occasionally sit with fellows and residents and give a lecture and share your wisdom. It is always an honor and pleasure to meet someone of your caliber but one might never see you on the hospital floor showing your magic. Why is that? You have taken on extensive administrative roles, spend more time in the laboratory and have less time to come and join us on the wards. While we understand your needs and desires to do other tasks, I wish that you would come back and share your wealth with us on the floor more often. Once a year, I see you come and do some time on the wards; I get very excited that you are able to give us that time. But that time is fragmented by meetings. You have cut short what you do best: teaching, caring for patients and inspiring young professionals. When we lose you to administrative duties, we lose the enthusiasm that you share with young and up-and-coming physicians that creates their passion for medicine. We lose the art of medicine. We lose doctoring…

Why is this Master important in the making of a good clinician? The role of such a person is enormous. A 67 year old male with prostate cancer is admitted for severe metabolic alkalosis, hypokalemia and new onset hypertension. A medical student can spend hours taking histories and performing physical exams, memorize a long list of differential diagnoses but yet not come up with the right diagnosis. This Master Clinician arrives at the correct diagnosis in a few minutes of meeting the same patient. “This is Cushing’s disease-ACTH production from the prostate cancer; start ketaconazole now!” Medical school teaches us the science of medicine and post graduate training showcases us the art of medicine. From being a good teacher and a great clinician, Master Clinicians such as yourself will demonstrate the art of medicine, the bedside teaching that medical students, residents and fellows should be learning. This individual will bring to the bedside their years of experience and thoughtful discussions of tough cases to make us all understand the basics of disease. You can inspire and create many more such Masters by your aura and presence on the floor.

In my career as a student and physician-in-training, the teachers who inspired me to become an Internist and a Nephrologist were all Master Clinicians and spent a lot of time with us - showing us physical examination skills, ways to think through tough cases and how to balance family and residency life. As a community of young physicians, we would like to extend an invitation to you to return and show to us your skills and enthusiasm. We understand the competing interests you have from administration, research and education. We can devise technological and novel ways of educating in the 21st century to enable you to return. Advances in technology can aid in teaching clinical reasoning. As I walk through the hallways of the hospital, I realize what is absent… it is the “Master Clinician”. We miss you!

Sincerely,

The Apprentice in search of a Guru

Comments on this article Comments (1)

Version 2
VERSION 2 PUBLISHED 13 Feb 2014
Revised
Version 1
VERSION 1 PUBLISHED 03 Jan 2014
Discussion is closed on this version, please comment on the latest version above.
  • Reader Comment 10 Feb 2014
    Kenar Jhaveri, Hofstra University, USA
    10 Feb 2014
    Reader Comment
    Thank you to the referees for their comments. I have taken into account a few of the suggestions in the next version. Due to the flow of the letter, not ... Continue reading
  • Discussion is closed on this version, please comment on the latest version above.
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how to cite this article
Jhaveri KD. A letter to the Master Clinician [version 2; peer review: 2 approved]. F1000Research 2014, 3:1 (https://doi.org/10.12688/f1000research.3-1.v2)
NOTE: If applicable, it is important to ensure the information in square brackets after the title is included in all citations of this article.
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Open Peer Review

Current Reviewer Status: ?
Key to Reviewer Statuses VIEW
ApprovedThe paper is scientifically sound in its current form and only minor, if any, improvements are suggested
Approved with reservations A number of small changes, sometimes more significant revisions are required to address specific details and improve the papers academic merit.
Not approvedFundamental flaws in the paper seriously undermine the findings and conclusions
Version 2
VERSION 2
PUBLISHED 13 Feb 2014
Revised
Views
12
Cite
Reviewer Report 08 May 2014
Laura Maursetter, Department of Medicine, University of Wisconsin, Madison, WI, USA 
Approved
VIEWS 12
I love it. It was an easy read and very compact. It made ... Continue reading
CITE
CITE
HOW TO CITE THIS REPORT
Maursetter L. Reviewer Report For: A letter to the Master Clinician [version 2; peer review: 2 approved]. F1000Research 2014, 3:1 (https://doi.org/10.5256/f1000research.3869.r3664)
NOTE: it is important to ensure the information in square brackets after the title is included in all citations of this article.
Views
26
Cite
Reviewer Report 17 Feb 2014
Ritu Soni, Division of General Internal Medicine, University of Pittsburgh, Pittsburgh, PA, USA 
Approved
VIEWS 26
I confirm that I have read this submission and believe that I have an ... Continue reading
CITE
CITE
HOW TO CITE THIS REPORT
Soni R. Reviewer Report For: A letter to the Master Clinician [version 2; peer review: 2 approved]. F1000Research 2014, 3:1 (https://doi.org/10.5256/f1000research.3869.r3663)
NOTE: it is important to ensure the information in square brackets after the title is included in all citations of this article.
Version 1
VERSION 1
PUBLISHED 03 Jan 2014
Views
42
Cite
Reviewer Report 10 Feb 2014
Ritu Soni, Division of General Internal Medicine, University of Pittsburgh, Pittsburgh, PA, USA 
Approved
VIEWS 42
Very well written. I can identify with the ideas expressed in this article. In fact, it reminds me of my medical schooling in India, during which we focused on honing our clinical skills rather than relying on diagnostic imaging/procedures, due ... Continue reading
CITE
CITE
HOW TO CITE THIS REPORT
Soni R. Reviewer Report For: A letter to the Master Clinician [version 2; peer review: 2 approved]. F1000Research 2014, 3:1 (https://doi.org/10.5256/f1000research.3384.r3569)
NOTE: it is important to ensure the information in square brackets after the title is included in all citations of this article.
Views
41
Cite
Reviewer Report 09 Jan 2014
Laura Maursetter, Department of Medicine, University of Wisconsin, Madison, WI, USA 
Approved
VIEWS 41
A very nice idea to use this avenue to encourage the master clinician to spend more time where they will make a big impact. That is great. To me this type of publication needs to be short and sweet, to ... Continue reading
CITE
CITE
HOW TO CITE THIS REPORT
Maursetter L. Reviewer Report For: A letter to the Master Clinician [version 2; peer review: 2 approved]. F1000Research 2014, 3:1 (https://doi.org/10.5256/f1000research.3384.r2957)
NOTE: it is important to ensure the information in square brackets after the title is included in all citations of this article.

Comments on this article Comments (1)

Version 2
VERSION 2 PUBLISHED 13 Feb 2014
Revised
Version 1
VERSION 1 PUBLISHED 03 Jan 2014
Discussion is closed on this version, please comment on the latest version above.
  • Reader Comment 10 Feb 2014
    Kenar Jhaveri, Hofstra University, USA
    10 Feb 2014
    Reader Comment
    Thank you to the referees for their comments. I have taken into account a few of the suggestions in the next version. Due to the flow of the letter, not ... Continue reading
  • Discussion is closed on this version, please comment on the latest version above.
Alongside their report, reviewers assign a status to the article:
Approved - the paper is scientifically sound in its current form and only minor, if any, improvements are suggested
Approved with reservations - A number of small changes, sometimes more significant revisions are required to address specific details and improve the papers academic merit.
Not approved - fundamental flaws in the paper seriously undermine the findings and conclusions
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