Friday, October 12, 2007

Remembering Proctor Harvey

W. Proctor Harvey, M.D., M.A.C.C., passed away on Sept. 26 at the age of 89. He was widely renowned as a master clinician and teacher of cardiac auscultation. His teaching sessions were legendary. I had the good fortune to attend a few of them at CME meetings through the years. Harvey taught, and demonstrated to his students repeatedly, that most cardiovascular disease could be diagnosed at the bedside.

Nowadays the abuse (wasteful, ineffective use, sometimes to the harm of patients) of sophisticated technology, especially in cardiovascular medicine, is common. That’s because medicine has lost the legacy of Proctor Harvey: the importance of basic clinical skills. Another master teacher, J. Willis Hurst, has said that unless one masters low technology (basic clinical skills) one is bound to abuse high technology. He said it here in this way:

When low technology, consisting of the history, physical examination, electrocardiogram, and chest x-ray film, is used poorly it is very likely that high technology will be used poorly. It is not possible to take a second step (high technology) without taking a well placed first step (low technology).

During my training it seemed there was never quite enough time to teach basic skills properly. Today there is even less time, given the many new and competing demands of medical education, not to mention all the fluff and woo. Now as in years past practicing physicians must teach and reteach themselves these skills.

Dr. Harvey realized that fact and at one of his CME presentations announced a collaboration with engineer David C. Canfield and Roche pharmaceuticals to capture live recordings of heart sounds from hundreds of patients, put them on cassette tapes along with a set of booklets to be distributed as freebies by drug reps to interested physicians. (Dr. Harvey, true to his reputation for humility, didn’t think it beneath himself to collaborate with a drug company to make this wonderful educational resource available!).

A tribute to Dr. Harvey in the Texas Heart Institute Journal described the project:

In recognition of the importance of his message, numerous educational grants have enabled the distribution of his writings to American medical students and physicians. Roche Pharmaceutical company alone is responsible for distributing 75,000 copies of Clinical Auscultation of the Cardiovascular System, a work that includes 10 high-fidelity audio cassettes of various heart sounds and murmurs, recorded from more than 450 patients, together with a text that describes the compendium of acoustic findings and their significance. Harvey's voice is heard throughout the cassettes as he sprinkles in his “cardiac pearls.”

I still have my set, pictured here.

Shamelessly and with no sense of “reciprocal obligation” I would like to express my thanks to Roche Laboratories for making this wonderful resource available.

For those who would like to feel morally superior by paying for this resource, last time I looked one was being sold on ebay.


Anonymous said...

thanks for the comment dr ramprekash! very insightful.

phone said...

Its just funny though, because we have come such a long way in just the last decade alone.