Aphorism-based medicine

Originating in speeches, personal diaries, journal entries, and haphazard conversations, aphorisms have endured time and become pillars on which patient care is founded and medical science is shaped. Most began as simple observations, but they have become recognized for their inherent truth.

Aphorisms are not evidence-based and are certainly not the result of double-blind studies, yet they continue to be relied on for the accuracy with which they describe unique aspects of medical practice. Some aphorisms, like the Mayo brothers' “The best interest of the patient is the only interest to be considered,” have remained cornerstones of major health care entities. Others, such as Hippocrates' scores of ancient medical treatments, have both remained a standard for medical treatment and revealed how medical science has progressed over time.

Some aphorisms have become established medical humor, like William Osler's sensual advice to find romance in the meeting of the head of the pancreas and proximal duodenum (“area of abdominal romance—where the head of the pancreas is enfolded in the arms of the duodenum, and the liver is nestled around”). Perhaps no aphorism is more appreciated by first-year medical students than Osler's warning about the effects of lecturing: “Superfluity of lecturing causes ischial bursitis.”

Analyzing these truisms can help one better understand how medicine has progressed from Hippocrates' time to that of Osler and the Mayo brothers. While Hippocrates' aphorisms were more focused on establishing basic treatment for disease, Osler and the Mayo brothers moved beyond treatment to describe the role of the physician in society and the communal aspects of medicine. For example, Charles Mayo's statement “Medicine is a profession for social service and it developed in response to social need” helped the health care industry to think of its relationship and responsibility to the larger community.

Still, a common theme found in the aphorisms of these 4 medical giants is their focus on the search for truth. Indeed, the nature of a physician's role requires him or her to seek truth in nearly every aspect of the job. The diagnostic process, for example, is by definition a search for truth. Every morning, the hospital physician rotates from room to room, sifting through a presentation of symptoms—clues of sorts—in search of a treatable diagnosis.

Hippocrates aimed to discover truth in the treatment of common diagnoses. One of his most famous aphorisms described one of these treatments: “Those diseases which medicines do not cure, iron cures; those which iron cannot cure, fire cures; and those which fire cannot cure, are to be reckoned wholly incurable.”

Sometimes the truth is not a medical diagnosis at all but a patient's verbally expressed wishes. At other times, the patient's family can attempt to best represent the truth. In still other situations, the law, accepted medical practice, and norms adopted by the current society can attempt to best represent the truth.

While all of these representations help guide the physician in the direction of truth, Osler, Hippocrates, and the Mayos declared the truth to be a moving target. William Mayo said, “We think of truths as ponderables capable of being measured and weighed, but introduce a new fact or a new thought and a new truth is developed.” Osler echoed this idea by stating, “Like a living organism, truth grows, and its gradual evolution may be traced from the tiny germ to the mature product.”

Being pulled among a number of different representations of truth, the physician must understand that truth is, in William Mayo's words, “a constant variable.” As these individuals have expressed, this constant variable is not independent of temporal processes, but rather very much dependent on the lens through which one views it. The aphorisms of Osler, Hippocrates, and the Mayo brothers continue to give the health care community a lens through which to view important themes in patient care and medical science.

As this lens continues to progress and develop, these foundational aphorisms allow us to stay grounded in the ideals on which medicine was founded. William J. Mayo said, “As I look back on these men who influenced me so greatly, I realize that their influence lay not in their craftsmanship, but in their high qualities of mind.” Whether one finds romance in the head of the pancreas or humor in the primary cause of ischial bursitis among medical students, these aphorisms give us insight into the minds of these medical giants and continue to serve as unparalleled teaching tools for future health care professionals.

With this in mind, we also recognize physician and writer Rudolf Virchow and his advice for aspiring writers: “Brevity in writing is the best insurance for its perusal.”