Of Chairs and Stools: —or, What's Academic about Academic Medicine?

OF CHAIRS AND STOOLS:—OR, WHAT'S ACADEMIC ABOUT ACADEMIC MEDICINE? DANIEL X. FREEDMAN* These meetings of the AAMC give various groups of chairs from the preclinical and clinical sciences an earned respite, a chance to realize that at the least—once again—some few of us have survived! While I note a few parochial issues that the chairs of psychiatry encounter, my underlying theme relates to the function of all clinical chairs in the modern medical school. I have often wondered why and how academics become chairs of clinical departments. We may arrive at the job with various mixtures of narcissism and altruism. For some, sheer "somatic destiny" drives us to such posts—an irresistible need to strive for order. Most of us seek opportunities to give what we did not receive or better than we did. And probably all of us wished to be certain that certifiable incompetence would not lead our academic departments! However we arrived at the job, battered or buttered, we should know that American medical schools are fortunate for the leadership they have recruited. They need us for survival, today more than ever. In the United States, the first chair was in 1765, in medicine, when John Morgan founded the University of Pennsylvania Medical College. The first professor—that is, chair—of psychiatry in a U.S. medical school was Samuel Mitchell Smith at Willoughby University in 1847. He eventually became dean of the college that was to be renamed the Ohio State University College of Medicine. Whether it is a diagnosis of medical schools or a fad, psychiatry chairs have recently been imitating Sam Smith, showing that even in the biology of institutional life, ontogeny recapitulates phylogeny! Yet This article is slightly revised from the second Distinguished Chairman's Lecture for the American Association of Chairmen ofDepartments of Psychiatry. The group assembled in San Francisco, October 1990, at the American Association of Medical Colleges' Annual Meeting. *Judson Braun professor of Psychiatry and Pharmacology, University of California School of Medicine, 760 Westwood Plaza, Los Angeles, California 90024-1759.© 1991 by The University of Chicago. All rights reserved. 0031-5982/92/3501-0759$01.00 Perspectives in Biology and Medicine, 35, 1 ¦ Autumn 1991 87 neither deanships nor chairs are readily filled today. What, then, is going on? For perspective on our schools, we have to look (pardon the expression ) at the stool—the classic, blessed three-legged stool on which our chairs are perched: service, teaching, and research. Many feel it is toppling—its legs stretched, its aspirations as an almost holy trinity beyond any real world grasp. We should, though, remember that our original and abiding purpose is to be at least the guardians of the knowledge base and to teach it in theory and practice. Attributed to the nineteenth-century American educator Mark Hopkins, there is now a fabled log conveying the essence of teaching—Hopkins at one end and the student on the other. In medicine, it is the student and teacher with the patient between. (To be precise, there are various versions of who had a log. Thus, some allude to Thoreau, who in valuing bare necessities , would advocate this minimalistic but essential school. John Romano, however, has provided me with the scholarly basis for my Hopkins metaphor . The twentieth president of the United States, James Abram Garfield , said the following in his address to Williams College alumni, New York, December 28, 1871: "I am not willing that this discussion should close without mention of the value of a true teacher. Give me a log hut, with only a simple bench, Mark Hopkins on one end and I on the other, and you may have all the buildings, apparatus, and libraries without him.") My major message is that, precisely because of chaotic distractions, we have all the more reason to keep a steady eye on such essential purposes. We are one of medicine's several clinical sciences. Therefore, any developments from whatever source or discipline that bear on our diseases and treatments must be sifted and sorted and taught. Our fundamental function is to teach students how to apply incomplete scientific knowledge to the cases before them—to think academic...