Why doctors (and doctor wanna-be’s) should read

I want to challenge my fellow pre-meds and aspiring physicians to read more. I want to suggest that a passage in Plato’s Dialogues, or a verse in a T. S. Eliot poem, is as important for our future medical careers as a chapter in Biochemistry6th edition. We are human beings before we are physicians, and the community of human beings of ages past demands our attention.

This past weekend, I got a chance to attend the 3rd annual Medicine & Religion Conference, hosted by the University of Chicago’s Pritzker School of Medicine. Philosophers, theologians, and healthcare professionals huddled to commiserate and pontificate, with the singular goal of pursuing a more harmonious relationship between (duh) medicine and religion. The Conference was mostly smart-talk – distant babble of academics – but I did come away with one conviction: in medicine, science is not enough.

The same phrase, oddly enough, appears in an address given in 1968 at the convocation ceremony of the American College of Surgeons. Then-President Dr. Preston A. Wade is, I like to imagine, speaking before a room full of recently initiated surgical fellows – eager to prove to the world (and their patients) their hard-earned prowess – only to urge them to undo what years of medical training had sculpted into the marble of their souls. He tells them, no less, to abandon their hardline devotion to science and technique.

I will quote at length from his address, because I think his words are worth noting:

“Today’s medical student makes his choice of profession, in a large measure, because of involvement in varying degrees with human suffering and his desire to alleviate it…Somewhere in the course of his medical education, the student becomes indoctrinated in pure science, or hard science philosophy, and tends to change his outlook, at least as he expresses it to his colleagues and his teachers, and adopts a much more hardened attitude toward medicine. It is obvious to him that anyone who continues to talk about studying medicine to alleviate human suffering may not always be popular with his colleagues. It is sometimes considered weak and rather childish to continue this attitude when one is struggling with intricacies of chemistry, biology, and physiology.”

It’s as if Caesar tells his army before a momentous battle that they’ve readied the wrong weapon (or, more accurately, not enough weapons).

The problem with a merely scientific or merely technical view of medicine is that it fails to recognize medicine as a human art, in which realities transcend neatly bounded categories and predictable outcomes. Even the routine prescription of statins for someone with high cholesterol can veer into the chaotic realm of emotions, spirit, and morality. As much as we would like to think, we – physicians or patients – are not merely material bodies.

To believe this is one thing, but to act on it is another. I have heard many medical students say, “I have to study right now – it’s for my future patients,” to justify why they are staying in with their science textbooks, rather than doing something else. Then there’s the system of ‘rotations’ in which the medical student becomes a nomad, jumping from clinic to clinic, field to field, with little time and space to be human themselves. Medical schools have a powerful set of rituals, and those rituals act as a ceramist, shaping his clay in very particular ways. After all, the decline of “empathy” among medical students by their third year of school is a well-documented phenomenon.

In the end, that is what I’m warning myself and others against: not the dedication of students to learning medical science, but the subtle transformation of that dedication into idolatry, a new religion, complete with its own rituals, merciless to its heretics. Refusing to bow to this new religion, perhaps, is no easier task than the holy defiance of Shadrach, Meshach, and Abednego against King Nebuchadnezzar. For the brave, the fiery furnace awaits, except that fiery furnace is a niggling and pernicious feeling that you aren’t doing enough compared to the others, that you will not make a good doctor.

What, then, does reading have to do with it?

Sherwin Nuland, a surgeon-writer who taught at Yale, famously said “You cannot forget too much science at the bedside.” When patients do not react the way we foresaw, or suddenly begin to cry at being told their diagnoses, or when, despite all of your attempts, they die, physicians will be clawing in the caverns of their souls for resources – for the words to describe what’s really going on, for the words to say back to patients to help them heal. Is a dying patient an impending code blue, or, as poet Dylan Thomas put, a fire, “rag[ing] against that good night”? Physicians must choose their words carefully.

Medicine, as I said, is a human art, and reading is an act of participation in the human community. As human beings, our community is not simply our contemporaries – those with whom we share a common time and space, and, therefore common limitations in perception. God has graced us with History, and the experience of those who have gone before us can color our vague outlines with paints we do not possess.

Every man falls under the cycle of birth, life, sickness, and death. Medicine deals with all of those things, and if we’re not careful to reflect on them and to seek the guidance of others (both present and past) during that reflection, we will very quickly find ourselves helpless to help others. I am not suggesting that reading (and engagement in the arts in general) will negate all of the tendencies in medical education towards disenchantment, jadedness, and science-worship, but it’s a very good place to start.

Daniel Song is attending medical school in the fall, and currently working as an intern at an inner-city primary care center in Chicago.

P.S.: For more details on the 2014 conference mentioned in the post, visit medicineandreligion.com/schedule.html

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6 thoughts on “Why doctors (and doctor wanna-be’s) should read”

  1. I agree. If fact, we desperately need to do more of ANY activity that touches our hearts and souls more than it does our brains. Reading is one of them; for some, it’s music, physical activity, etc. It’s all in line with the new effort to promote “mindfulness” among medical students and physicians – to decrease burnout and alleviate the mental and spiritual strain that comes from pursuing this career. But as much we all recognize the need to “be more human”, WHY then does the purely scientific/jaded/workaholic automaton still exist in such abundance? I would argue that the current system of medical education and practice makes it very difficult to pursue the “extracurricular” activities that help us become better doctors. The expectations we feel are huge and daunting: that we have a near-perfect knowledge of medicine, and be nice sane people to boot. Most allow the latter to slip first, because after all, the patient would rather you save his life than you be able to whisper kind words as he dies…right? So how do we re-conciliate the two? I think that’s the conundrum we face as students of medicine.

    1. I’ve been skimming through “Habits of the Heart” recently (on Daniel’s recommendation), and an interesting observation is posed by these sociologists studying American individualism:

      “…when one can no longer rely on tradition or authority, one inevitably looks to others for confirmation of one’s judgments. Refusal to accept established opinion and anxious conformity to the opinions of one’s peers turn out to be two sides of the same coin.” (p. 148)

      In light of the collapse of tradition and the rise of “social mobility”,

      “The only clearly defined cultural standards against which status can be measured are the gross standards of income, consumption, and conformity to rational procedures for attaining ends. Middle-class individuals are thus motivated to enter a highly autonomous and demanding quest for achievement and then left with no standard against which achievement is to be measured except the income and consumption levels of their neighbors, exhibiting anew the clash between autonomy and conformity that seems to be the fate of American individualism.” (p. 149)

      In other words, for Bellah et. al. it is precisely the lack of a sense of community identity that generates a social anxiety which makes it so easy to find life meaning in the attaining of “technical competence”. The problem is partly with the entire conception of “medical knowledge”:

      “…the middle class sees ‘individual and social behavior as predominantly determined by the application of technical rules to any situation that arises,” whereas the lower class (and, interestingly enough, the upper class) have a more ‘dramaturgical view of social action’ …action that takes on meaning because of a particular history of relationships. Abstract rules are less important than the examples set by individuals.” (p. 151)

      In other words, the assumption that “medical knowledge” is true knowledge is based on the assumption that such technical knowledge is universally effective and can be universally applied. But that is an illusion. True knowledge is not only technical, but must also understand the scope and limits of technique. It must know when it would help and when it wouldn’t. Is it worth it to “save someone’s life” but to lose their soul? Is not life more than mere physical existence?

      Just some thoughts.

    2. @shangela I agree. A lot of the transformation is due to imposed expectations, and part of me thinks that it is not enough for individual students to fight back – something systemic needs to be in place here. But the problem I guess is that not everybody agrees that the shift away from a less “intense” medical education is a good thing.

  2. @ekuo I thought that argument was Bellah’s finest and most insightful. Without community identity and tradition, we wander anchorless in this treacherous world and turn to things that give us at least the semblance of control (i.e. technique, technical competence). I think this is true for the ethic of politics in the US now too. We have very few political leaders who are moral compasses (deeply rooted in a tradition), and lots who are technocrats who know how to manipulate things to achieve a desired outcome.

  3. yeah danyo don’t you wish you’d done the HUM sequence now??
    hahahah kidding. of course i love this post. yes to reading and humanities and all things that make you dig and explore how to be HUMAN, and yes to doctors also needing to know that, as well as engineers, economists, physicists, consultants, EVERYONE.. i’m thinking of jeff nunokawa at his senior talk thing last spring telling us why we need literature, bc at some point life will bring us suffering and it will be crushing and in that second we will need literature to remind us that we are not alone…

    of course ALSO we will have Christ and His Spirit, real and near, and our ludicrous hope built on faith in Him. wow we are all insane hahah but in the best way.
    anyway.
    hoorah for reflection, reading, history and philosophy and literature and all that floofy humanity stuff that actually turns out to be lifeline/CRUCIAL/gold

    oh just a thought/whim though, how would the opposite apply? would you write a post saying “why writers (and writer-wanna-bes) should study biochemistry?”
    HMMM
    real question actually..

    1. I would say the opposite applies as well, although only if 2 things are true: 1) if science can get away from looking down on the humanities and from considering its discipline/method as THE definitive way of looking at the world (i.e. being clear about the limits of science and admitting that science is not philosophically ‘neutral’/objective) 2) if science can temper its tendency towards hyper-specialization and teach students to appreciate more connections and systems.

      I’m guessing the two are related

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