Everyone agrees that Osler’s greatest contribution to medicine was the recognition that physicians (whether students or old timers) learn more from their observations and conversations with patients than they do from books: “Medicine is learned by the bedside and not in the classroom”, and that is why our teachers, by their own example and by the critiques of our early interviews, taught us to ask open-ended questions and to listen attentively and respectfully while patients told their stories. 

- Osler and the Way We Were Taught

The practice of medicine is an art based on science.

- Sir William Osler

سلام الله على أوسلر

Patients, as a rule, want to understand the meanings behind their illnesses “Why me?”, “Why now?”, “What lesson is this meant to teach me?”, “What did I do to deserve this?”
They hope to engage their physicians in the quest for answers, but physicians today are more interested in questions they can more easily answer: “What genes?”, “What proteins?”, and “What nerve pathways?”
Existential queries are dismissed as humanistic marginalia, no longer central, as they once were, to medical practice.

- Osler and the Way We Were Taught

إنّ الطبّ بالدرجةِ الأساس يتَعامَلُ مع المريضِ وليسَ مع المشاكلِ البيولوجية (الأمراض) بحدّ ذاتِها، لأنّ المرض لا يُصيبُ المريض على المستوى البيولوجي فقط: من وجهةِ نظر المريض، هو "عِلّة" تَعبَثُ بكيانِه كُلِّه على المستوى الإجتماعي والنفسي والمالي حتى. بكلماتٍ أُخرى: المَرَضُ مشكلةٌ وجودية، لأنّه يُسَمِّم وجودَ الإنسانِ كُلَّه.

لهذا فإنَّ الطبَ، في تعامُلِه مع المريضِ بمرضِه (البيولوجي) وعلّتِه (الوجودية) معًا، هو أيضًا مُحَمَّلٌ بكلُ أنواعِ التَبِعاتِ العِلمية والإجتماعية والأخلاقية والنفسية وحتى الفلسفية.

Read it, it's great

History taking and careful observation (not laboratory results) were the authority upon which differential diagnoses and initial treatment plans were built. Laboratory tests confirmed (or not) our hypotheses, not the other way around.

- Osler and the Way We Were Taught

Cerebral salt-wasting (sometimes called renal salt-wasting)

The most common presenting story for cerebral salt wasting is hyponatremia after aneurysmal subarachnoid hemorrhage. A few days after the hemorrhage the patient’s serum sodium begins to drop while the urine sodium increases. The patient’s fluid status also decreases, and the patient becomes hyponatremic and hypovolemic.

It is important to distinguish between cerebral salt wasting and SIADH as the two are treated with opposite treatment strategies. For cerebral salt wasting the patient is given fluids and sodium supplementation. For SIADH the patient is fluid restricted.

Brain natriuretic peptide (BNP) is a bitch, and no one can change my mind about it

Hyponatremia + hypovolemia = Cerebral salt-wasting (CSW).

Hyponatremia + euvolemia or hypervolemia = SIADH.

The key to understanding the pathophysiology, signs, symptoms, and treatment of SIADH is the awareness that the hyponatremia in this syndrome is a result of an excess of water and not a deficiency of Na+.

Patients with this type of aphasia usually have profound language comprehension deficits, even for single words or simple sentences. This is because in Wernicke’s aphasia individuals have damage in brain areas that are important for processing the meaning of words and spoken language. Such damage includes left posterior temporal regions of the brain, which are part of what is knows as Wernicke’s area.