The center of your universe

You start your morning rounds. You will spend the next 12 hours doing the electronic equivalent of shuffling papers and wading through red tape as you make complex medical decisions, elicit fascinating physical exam findings, cut and paste ad nauseum, admit and discharge a barrage of patients and sleep peacefully through meetings. This is your world. And you are the center of it. Everything you do and think may be interpreted from the context of how it affects the most important person: you.

The emergency department calls; there are three admissions waiting. You become hypertensive. The nurse calls you from a floor on the other side of the hospital and wants you to see a patient that she is worried about. You become tachycardic. The medical student wants you to explain renal tubular acidosis. You become nauseated. The utilization review nurse and clinical documentation specialist both need record clarifications. You become delirious.

Why are they all bugging you? Don't they know you have things you need to get done? Of course, to each of these colleagues, from student to administrator, you are the annoyance, the non-responding rock in their shoe. But isn't it all about you?

About 500 years ago, an astronomer, polyglot, mathematician, clergyman and Renaissance man about town was dealing with the question of the center of his universe. Nicolaus Copernicus was also a physician. His contribution to astronomy, the helicocentric model of the universe, was without precedent. He showed, with evidence of astronomic observation, that it was not the earth but the sun that was the center of our universe. This was not a universally appreciated view. The first printing of De revolutionibus orbium coelestium is said to have been placed in his hands on his deathbed, as he lay in a coma after a stroke.

Copernicus began his medical journey at the University of Padua, the “Athens of the Renaissance.” However, his tenure there was short lived as he was summoned back to Poland by the Catholic Church to seek permission to continue his studies. He would return to Italy after several years, but not before stopping in Florence to appreciate Leonardo da Vinci's anatomical drawings, all of which were based on cadavers. This was a period truly rich in medical exploration and Copernicus found himself at the center of an intellectual hot spot: Padua, Ferrara and Bologna. At the three universities, education was not limited to classical systems of study but rather intertwined across a number of fields including philosophy and astrology. The works of Hippocrates, Avicenna and Galen were on the requried reading list. Although there is no official record of Copernicus graduating, there is no doubt that he became a practicing physician.

Returning to his native land, he continued to pursue physics, astronomy and mathematics at night, but also cared for the sick and needy during the day. As an ecclesiastic he waived all medical fees and tended primarily to the poorest community members. His outcomes were impressive and soon word spread across the country as well as into the far reaches of Europe. Over the years he would find himself being called upon by dignitaries such Duke Albert of Prussia. The Duke referred to him as “the most learned and gentle of men,” a reputation which many of his colleagues also bestowed on him as they frequently requested consultations. Copernicus would often travel long distances to meet with physicians and even offered his services to epidemic areas.

Copernicus caused a huge shift in the human perspective towards the universe (although it's unlikely that the universe took notice of this). When we have strong views of how things are, it is hard to view it in a different way. When William Harvey demonstrated the circulation of blood to Professor Caspar Hoffman about a century after Copernicus he said, Video sed non credo. “I see it but I don't believe it.” When our view of how things should be is challenged, we have to ignore it or accept it, or find something in between.

The emergency department calls you with three admissions. From your universe you wonder “Why are they dumping on me?” But to the ED physician, there are 42 patients in the waiting room and an ambulance en route with a code in progress. Beds need to be cleared. A quick walkthrough reveals three patients waiting to be admitted. And the ED doctor thinks to herself, “Why is that darn hospitalist so obstructionist?”

The core value of the Mayo Clinic is that the needs of the patient come first. We practice in the age of patient-centered medicine. Remember, to each hospitalized patient, he is the center of the universe and you are just a satellite who occasionally enters the gravitational field.