The elements of medicine: faith, hope and credence.

till I have worked up my patients into a confidence bordering upon certainty, of their probable good effects.” William Osler, the most prominent physician of the 20th Century, remarked: “Faith in us, faith in our drugs and methods, is the great stock in trade of the profession.” In Osler’s iconic textbook (which has guided medical students for over four generations), he said that three factors will lead to therapeutic success: A strong personality in whom the patient has faith; a healing environment rich in symbols such as a shrine, a sanctuary, or for those in medicine, a hospital with skilled nursing care; (Osler, who founded the Johns Hopkins Hospital and Medical School, referred to the institution as Saint Johns Hopkins.) The third factor was the patient’s “active belief in the assurance of the physician.” Medicine, before the era dominated by MRIs and other intrusive paraphernalia, still had its visible symbols: the wellworn stethoscope, the pocket watch to determine the patient’s pulse, and most of all, the atmosphere of optimism, equanimity, assurance and self-confidence emanating from the physician. The physician’s ambience was not marginal; it was all. In the formative days of Johns Hopkins Hospital, Osler was called to see a mortally ill boy named Billy O. The urgent call came when Osler was presiding over the medical school graduation, and in his haste to arrive at the child’s bedside, he neglected to remove his ceremonial robes. This then was how the child had first envisioned him; and for the next forty days, Osler visited Billy daily, always wearing his academic robes. Osler talked at length with Billy, fed him with his own hand, and somehow urged Billy’s body to heal itself. Billy recovered, although Osler had no explanation. In medicine’s quest for meaning, its search for plausibility, and its insistent demand for rational explanations, it recognizes intuitively that there must be more operative elements than the intricacies of the immune system, the endocrine glands, the hereditary equipment and other wondrous modalities governing mortal encounters between illness and its victim. Somehow, somewhere, passions must influence the capacity of the body to confront its disorders. If not blind faith, then certainly some faith in the healer’s skills exerts a role in the subtle negotiations that culminate in either healing or non-healing. The physician, as custodian of the healing adventure, must be assertive and have faith in the process until such time when a pharmaceutical company devises a pill to activate the patient’s sense of confidence in himself and his physician.