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A defense of the liberal arts, and how an understanding of art and religion is essential to the practice of medicine.

The impetus for this month’s column was a recent interaction at a social gathering in a university town. The conversation, as is common in such settings, was steeped in cultural relativism, proclaiming the brilliance of Jacques Derrida and Michel Foucault and how everyone would be better off if the intelligentsia ran the country. A graduate of the public health school was advocating the warp speed production of doctors to relieve his imagined shortage in the United States. “After all,” he opined, “they are basically simple technicians and the need for anything more than two years of undergraduate science is more than enough to meet their minimal requirements for clinical medicine.”

For those of you who know me, it will come as no surprise that my blood pressure required a nitroprusside drip at this point. I couldn’t help turning to the professor and asking, “What’s the real difference between an MD and a PhD?” While he was thinking, I answered: “About a $100,000 a year, and for good reason.” I then found other company for myself and my beloved gin and tonic.

The idea that a physician does not need a “real education” is ridiculous. Perhaps it stems from the intellectual framework of Richard Dawkins and Richard Rorty, who suggest that humans are just mammalian weeds who have overpopulated the earth. If this were so, perhaps a purely statistical approach to medicine would suffice. But people need to be dealt with one at a time – in fact, it is our individuality that makes us human. We are the only species which has inherited culture, can contemplate its origins, and is aware of its inevitable death. Joy and sorrow, pleasure and pain have been passed down in writing for at least the past 5,000 years such that we can use these thoughts and experiences to supply meaning to our own lives.

Just one time, I would like to hear the learned professor admit the force of faith in human history. Please admit that before the last half of the 20th century, it was the faith and hope of humans that dominated creative efforts and beliefs. Without this spirited source, the motion of the human experience swings wildly between complete individual license and total state control. The founders of both European and American liberty, such as Locke, Kant, Jefferson and Adams, used an eternal set of values as the strategic grounds for the defense of human rights and individual dignity.

For those who do not believe that anything exists outside the four dimensions that we measure, I ask you: “What happened a nanosecond before the big bang?” The best of my friends in physics are stymied by this question. Until you have an answer to this ancient dilemma, don’t criticize those patients who still believe in a power and force which is not yet understood. After all, what separates us from all the other fauna and flora in the world is this belief and search for meaning. Any doctor who cares for patients, yet cares nothing for this 5,000-year search for meaning, is missing the mark.

This search for meaning sets the tone for all relationships, both private and professional. To not understand the concept of belief is to miss the point. I am not the fidei defensor of dogma. But I do agree with the philosopher Alastair MacIntyre’s argument that emotive propositions have replaced rational discourse over moral ends. Science alone will not save us. The Germans in 1939 had great scientists. That didn’t save them, and it almost destroyed us. Science is never immoral or moral; it is amoral. It is our core fundamental beliefs and philosophical educations which help us apply science to the benefit of the individual. Just because we can do something, doesn’t mean we should do something. Belief is the governor on our actions.

I had a seriously bookish childhood. I spent more time outdoors than most of our children do today, but my innate lack of athletic ability made me suitable only for the track team. My books were my companions and I sought adventure alongside Homer, Tarzan and Huckleberry Finn. I can state without equivocation that I never read anything that didn’t make me a better doctor. From soup can labels to Cervantes, it has made me aware of my world and the people I had the honor of caring for. I also never had a job that didn’t make me a better doctor, from being a construction clean-up boy and yardman to working in the steel mills in Detroit to playing in rock-and-roll bands. It all made me better at my ultimate work. I feel sorry for medical school graduates who get their first real paycheck during their residency. The technician knows everything about their job. A professional knows how that job relates to a person. It is to make the patient’s life – and death – more meaningful. That separates us in the broader perspective from just the nuts on bolts aspect of our job.

I resent the idea that I am a mere functionary. I resent the concept that a few basic science courses can replace a knowledge of the stages of “big history,” which have formed and informed the human race. I reject the very idea that there is a simple equation to solve all the myriad of human pathology with which an emergency physician has to deal with every day. Find me the differential or integral solution for what to say when you have to give back to a young couple their crib death infant. The biggest problem with the young is they have not yet felt pain or suffering. The problem with those of us who are old is we have seen both of these vicissitudes too much. I am a better doctor for having raised three children. I’m a better doctor for having buried parents and a brother.

I fully expect that among my readers will be believing Jews and Christians, agnostics and atheists, the politically liberal and conservative (with all the attendant subcategories therein). But the one thing we should have in common is that we should be people of goodwill and intelligence who are able to use persuasion and be persuaded of the importance of the fifth dimension and the value of a liberal arts education to the public life and the practice of medicine.

 

Comments   

# john dale dunn 2012-07-11 07:32
Greg Henry and Mark Plaster continue to provide thought provoking and valuable commentary on the current state of medicine and the profession.

I am always impressed by their wisdom and scholarship.

I would reemphasize another comment that the cost of all the emergency department visits in the country- somewhere north of 120 million, is a small amount and cost is not lost revenue. Consider the size of the healthcare budget, real expenditures, of 2 trillion plus and the cost of ED or the cost of the uninsured is less than 5% in both categories, pocket change.

Robert Williams showed in his PhD thesis many years ago on marginal costs of ED visits, that ED care is actually efficient and competitive with office care. There is a distortion created by the access to tech and high cost lab and radiology in the ED, but most people who are really sick are better off in the ED, and reasonable efforts to control use of lab and rads on level 4 and 5 cases (non emergent) would make ED care a convenient and accessible way for people to get care compared to waiting for an appointment to see an office based practitioner.
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# MDPaula Pearlman 2012-07-11 08:56
Bravo, Greg. I've always believed that the requirements for medical school should include courses in the humanities and liberal arts. My knowledge of foreign languages has helped my practice of medicine far more than knowledge of all the enzymes in the Krebs cycle.
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# William Graffeo M.D. FAAEM 2012-07-12 12:31
I first met Greg Henry during my residency years at Univ. of Cincinnati when I was starting to look for a post residency job. It has been a great pleasure to read his articles and hear and meet him at EM conferences during the past 30 years I have been practicing. When I read this article all I could feel was that it is good to know there are still a few of us who still believe in the art of medicine and practice it as a vocation, not just as a job. I'm proud to say that I have shared some of the same feelings and experiences as Dr. Henry in my childhood and adult life. Keep up the good work Greg, we need to spread your message!
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# Thank You GregBrian ONeil 2012-07-16 09:15
Thank you Dr. Henry for elegantly covering an issue that has become taboo even in an industry that has a mission not a occupation. It is impossible to deny the power of faith in ourselves and our patients and to deny it mitigates a potentially powerful therapeutic tool.
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