William Osler (1849–1919) at the Roots
ofEvidence-Based Medicine
Marleide da Mota Gomes, MD, PhD, and R. Brian Haynes, MD, PhD, FRCPC
About the Authors
Marleide da Mota Gomes is an Associate Professor, Institute of Neurology, Federal University of Rio de Janeiro, Rio de Janeiro, Brazil.
R. Brian Haynes is Professor Emeritus, Departments of Health Research Methods, Evidence and Impact, and Medicine, Faculty of
Health Sciences, McMaster University, Hamilton, ON, Canada.
Corresponding author’s email address: mmotagomes@acd.ufrj.br
Submitted: February 7, 2019. Accepted: February 25, 2019. Published: November 19, 2019. DOI: 10.22374/cjgim.v14i4.345
ABSTRACT
2019 marks the centenary of the death of William Osler, a Canadian by birth and internationally
regarded as a leading physician of his time. His work, in Canada, the US, and the UK and
eloquent writings spread his knowledge, thinking and way of practicing and teaching medicine.
He advocated for the patient, rather than the disease, as the focus of medical practice, and his
writings demonstrate his concerns for matching practice to the patients circumstances and
expectations, honing the physician´s clinical skills, and using the best scientific evidence available
at the moment.
Osler’s approach is regarded by many as the beginning of modern medicine and has some
interesting coincidental and intentional connections with evidence-based medicine (EBM) of
current times. By coincidence, Osler was raised in Dundas, now part of Hamilton, Ontario, the
eventual home of David Sackett, a Canadian by choice, who led the current era of EBM. Both
began their academic careers at Canadian universities and ended their careers as professors at
the University of Oxford. By intention, EBM emphasizes a critical mind, appraisal, and use of the
scientific literature, and incorporation of the patients circumstances and preferences in reaching
clinical decisions. The clinical epidemiologic science that underpins EBM is quite different from
the observational pathophysiologic reasoning of Osler, and Osler may or may not have approved.
In any event, many of his writings hold true for current medical practice.
Resume
2019 marque le centenaire de la mort de William Osler, un Canadien de naissance et considéré
à léchelle internationale comme lun des principaux médecins de son époque. Son travail, au
Canada, aux États-Unis et au Royaume-Uni, et ses écrits éloquents diffusent ses connaissances,
sa pensée et sa façon de pratiquer et denseigner la médecine. Ses écrits démontrent son souci
dadapter la pratique à la situation et aux attentes du patient, daffiner les compétences cliniques
du site physician´s et dutiliser les meilleures preuves scientifiques disponibles à l’heure actuelle.
Lapproche dOsler est considérée par beaucoup comme le début de la médecine moderne
et a des liens intéressants de coïncidence et d’intention avec la médecine fondée sur des preuves
(EBM) des temps actuels. Par coïncidence, Osler a grandi à Dundas, qui fait maintenant partie
de Hamilton, en Ontario, où David Sackett, un Canadien de son choix, a vécu à lépoque actuelle
Canadian Journal of General Internal Medicine
Volume 14, Issue 2, 2019 23
Mota Gomes et al.
CJGIM_4_2019_172948.indd 23 11/8/19 12:17 PM
de la MFP. Tous deux ont commencé leur carrière universitaire dans des universités canadiennes
et ont terminé leur carrière comme professeurs à l’Université dOxford. Par intention, la MFP
met laccent sur lesprit critique, lévaluation et lutilisation de la documentation scientifique et
l’intégration de la situation et des préférences du patient dans la prise de décisions cliniques.
La science épidémiologique clinique qui sous-tend la MFP est très différente du raisonnement
pathophysiologique dobservation dOsler, et Osler peut ou non avoir été approuvé. Quoi quil
en soit, bon nombre de ses écrits sappliquent à la pratique médicale actuelle.
Keywords evidence-based medicine, health, patients, medicine, William Osler, history of medicine
William Osler (Figure 1) was an outstanding physician, known
for many virtues that deserve to be remembered along with the
pioneers of integrating scientific observations into medical practice,
such as James Lind (1716–1794), Pierre-Charles-Alexandre Louis
(1787–1872), and Ignaz Semmelweis (1818–1865),
1
and, more
recently, the evolution to evidence-based medicine (EBM).
2
Many of his published works were exceptional in his time and
his aphorisms still have relevance and inspirational importance
for the present.
3
This paper is a tribute to William Osler for his influence on
medical training and practice including precedents for evidence-
based medicine.
William Osler’s Biographical Sketch
William Osler was born on 12 July 1849, in a parsonage at
Bond Head, Tecumseh County of Upper Canada, now in the
province of Ontario. His English-born fa