Medicine need not be confined to the role of cultural bellwether, a sheep with a bell on its neck that reveals where the whole flock is headed. Along with other professions such as law, clergy and education, medicine can and should play the leadership role of a shepherd, helping our society to develop more thoughtful, balanced and generous approaches to the challenges that face us. After all, the word doctor means teacher, and our culture needs the best instruction we can offer. The dawn of a new year makes the time ripe for such a shift in medicine’s role.
Doctors as teachers
In serving as educators, doctors have many resources to draw on. They are among the best educated groups in our society, having pursued one of our the longest and most intense courses of study. In practice, they regularly participate in moments that help to clarify what life is all about – birth and death, growth and aging, suffering and relief. And they serve as trusted confidantes and counselors to patients and families at some of life’s most meaningful moments.
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Popular culture has reflected an erosion of the doctor as teacher and role model. In the 1960s and 70s, television doctors such as Dr. Kildare and Marcus Welby epitomized virtues such as dedication and compassion. Then along came “M.A.S.H.” and “St. Elsewhere,” which adopted a more irreverent attitude toward medicine and the people who practice it. By 2004’s “House,” which ran for eight seasons, the doctor had degenerated into a clever but deeply misanthropic opioid addict.
First, do no harm
As a physician and educator, I think that, for medicine to help heal our culture, doctors must embrace their role as advocates for principles that have long represented the core of the healing professions. Although “Primum non nocere, or ”First, do no harm,“ does not appear in the writings of the “father of medicine” Hippocrates, it is often cited as medicine’s first principle. And the idea that doctors should avoid harm is part of the modified Hippocratic Oath that most doctors take when they graduate from medical school.
This principle does not imply that doctors should never harm. After all, no surgeon could ever operate and no oncologist could ever administer chemotherapy if they rigorously adhered to it. It means instead that risks and harms must always be balanced against benefits, and that where the balance is too uncertain or unfavorable, it is better to do nothing. More broadly speaking, we should avoid saying things or acting in ways that cause needless injury.
What would “Do no harm” look like in our popular culture? First, it would mean eschewing personal attacks, which seek to label people as unworthy, disgusting, or evil. In public discourse, our goal should be to understand different points of view, to educate one another, and to take the interests of others into account in arriving at decisions. Physicians are expected to take good care of even patients they find disagreeable, and this an outlook sorely deficient in the U.S. today.
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A second habit deeply ingrained over the course of medical training is to recognize that there are usually more than two sides to any question. Suppose a patient complains of pain in the right lower quadrant of the abdomen, a classic symptom of appendicitis. Only poor physicians would confine their attention to the question, “Is it appendicitis or not?” The real issue at hand is to determine what is causing the pain and what needs to be done about it.