In lieu of an abstract, here is a brief excerpt of the content:

C H A P T E R N I N E T E E N A Hippocratic Triangle History, Clinician-Historians, and Future Doctors Jacalyn Duffin Declare the past, diagnose the present, foretell the future; practise these acts. As to diseases, make a habit of two things—to help, or at least to do no harm. The art has three factors, the disease, the patient, the physician. The physician is the servant of the art. The patient must cooperate with the physician in combatting the disease. HIPPOCRATES, Epidemics I, XI. STORY: The Walk Every Thursday afternoon, I put on my lab coat, checking the right pocket for my stethoscope (red for blood) and the left for my prescription pad (almost never used). Without an overcoat, even at –20\ C, I walk the length of Stuart Street to the hematology clinic. The short trajectory takes me past the medical school, its library and labs, under the windows of deans, across the old and new entrances to the Kingston General Hospital (a National Historic Site), near two main lecture halls, and between several stately homes converted into offices for clinicians and patientsupport groups. It is a useful walk. Corner consults with faculty expedite administrative matters. More effective, however, are the encounters with medical students. They smile or nod hello; a few stop to tell tales of their courses, love affairs, exams, and residency aspirations. Some, especially the newcomers, do a double take when they recognize me in this costume. At the next history class, they will listen more closely. Practicing hematology does not make me a better medical historian, but it helps to draw the attention of my audience of future physicians. As a clinician-historian working in a medical center, I have been asked by the editors to consider history written and read by clinicians, how it might have changed in the last two decades, and how it could be used in teaching. What A Hippocratic Triangle 433 stories from the past should we bring to future doctors? If they listen readily to a historian who is also a clinician, could it be that doctor-written history would be best? In this unapologetically subjective paper, I explore the analogy between historical practice and medical practice, both methodologically and conceptually. The Hippocratic triangle of doctor, patient, and disease finds an analogy in the relationship between a historian, her sources, her audience, and the histories that they build together. Then, I examine the so-called genre of clinician history over the last few decades to conclude that there really is no such thing: an M.D. degree is not a predictor for subject, method, or style; history is written by individuals. Finally, I turn to the role of audience, particularly medical students. Not only do my medical-student listeners influence the history that I write—they also influence me as a individual at least as much as I hope to influence them. I deny that clinician history is a genre, but my audience reminds me that being (perceived as) a clinician is part of my identity as a historian. Hippocratic Triangles: History as an Analogy for Medicine STORY: Historical Practice and Medical Practice I harbor doubts about my clinical abilities, especially on Thursday at noon. Will this be the day that I hurt someone? Yet the nursing station at the end of the corridor and the warm greetings of the outpatient staff put me at ease. It feels like home. Here, I understand the task, the banter, the humor, the resident-paging fascination of a big spleen with a bruit in room #12, and the importance of completing the requisitions with care (although I always need an update on their location and format, which seem to be altered every week). In the consulting room, I love talking to the patient, eliciting her story—‘‘elicit’’ not ‘‘illicit,’’ but enticing enough to imply a connection. When it is done well, method disappears into pleasant conversation. A differential diagnosis of the possible explanations (diseases) emerges by the end of our chat. A physical examination is essential to the consultation. No relevant sign must be left untried. I contemplate the centuries of wisdom that molded the intimate rite of those formal maneuvers of touch, and I adore the elegance of discernment, draping, and display. I think of Laennec every time I auscultate a chest. Then, further investigations are to be ordered: blood tests, X rays, scans, and biopsies. A vocabulary of signs...

Share