Meditations of a Conscientious
Hans Madueme, MD
In the hands of the discoverer, medicine becomes a heroic art...
Wherever life is dear he is a demigod.
Physicians, of all men, are most happy; whatever good success soever they have the world proclaimeth, and what faults they commit the earth covereth.
Like the English monarchy in its former glory, the medical profession has borne those esteemed images of nobility and honor. The physician embodies the great ideals of society and the fulfillment of untold parental aspirations. He champions the cause of the sick and afflicted, brandishing a lance of clinical acumen with healing skill and compassion. Such is the physician, it is declared, a messianic answer to the relentless scourge of disease and death. This perception, sacrosanct to some, is pregnant with an energetic romanticism. The time, perhaps, is overdue for a fresh canvas, even if the new picture lacks the finish of a treasured Picasso. This task of distilling the essence of a worthy doctor, more than likely, strikes a chord of manifest indifference. However, as Plato's Phaedrus explains, "Things are not always what they seem." Or, to counsel many a young man, beauty is more than the garb of an enchanting countenance.
To borrow a picture from Mortimer Adler's classic, it is the duty of the pitcher --- more or less --- to deliver a good ball to his catcher. An earnest writer, in like manner, strives to communicate knowledge to the reader. When the two have "come to terms," the faithful exchange of ideas has taken place.(1) In speaking of a good doctor, then, the question of definitions arises. What is meant by the term good? Sentiments of moral purity may reflect a bygone era, while others might envision the idea of impeccable professionalism and persistent excellence. This notion of a bonus medicus, it would seem, presents a slippery challenge to the inquiring mind.
The eager apprentice, in the harsh trenches, claims sole prerogative to the appellation of MD. As if to justify this cherished dogma, he appeals to many an adventure, such as hours of painstaking intimacy with silent, unknown cadavers. Others contend that the trained ability to speak in another tongue, mastering tales of "hematocrits" and "acute abdomens," is the definition of authentic doctorhood. A skeptic, risking the ire of the medical fraternity, may judge that a doctor is anyone with enough money who wants to call himself one. While caricatures have some dubious journalistic application, it is helpful at this juncture to solidify a more convincing view of our esteemed subject.
One may ask whether the badge of orthodoxy is limited to peddlers of allopathic(2) goods. Received wisdom, whoever decides these matters, has established as downright heresy any novel approaches to the healing model. To the extent that the alleviation of human suffering is realized, however, the traditionalist slander of quackery may be unwarranted. One of their own has confessed that "We prefer to judge insiders by our intentions and outsiders by their results. When in conventional medicine the mechanisms are unknown, we plead the empirical results. When the empirical results are against us, we plead the cogency of the mechanisms."(3) Granted, there may be legitimate problems with alternative medicine,(4) but this de facto professional marginalization is, on some level, a thinly disguised imperialism.
The doctor, of whatever persuasion, has studied the manifold expressions of sickness that beset the body. Yet avoiding the error of reducing man to, as Alvin Pam puts it, "homo biologicus --- something on the order of a highly evolved, intricately wired, and socially verbose fruit fly,"(5) he considers the entire person. The disciple of Hippocrates may be unschooled in the elaborate explorations of the mind, or the burgeoning lore of psychiatric pharmacopeia. But he understands the frailty of the human frame, and cares for those caught in personal affliction. The curator of the soul was viewed as the medieval priest, to be sure, but the good doctor also invested in non-physical real estate.
Like the aurora borealis on a cold winter night, the semblance of an answer begins to take shape. A doctor, roughly, is one with the calling to relieve human physical and non-physical suffering. He diagnoses disease and manages chronic symptoms. Happily, he does cure some sickness, though with no uniform regularity. Greeks of old might have said that, like their legal assistants, the doctor is a parakletos, an advocate called to the patient's side. He is also, like most of us, a man of enduring relationships. Accordingly, he is not bound to sacrifice his life at the altar of medicine --- a life that in its purest form, extends fully to spouse, friends, strangers, and family. The physician's gospel, the patient comes first, is therefore in need of amendment, since we too readily eviscerate compelling duties on a silver platter of extravagant (and imagined) vocational obligations.
Through the transparent decorum of modern society, the doctor has seen the emptiness and spiritual poverty that are the lot of every man. Indeed, in company with Arthur Leff and others, he has grasped that reality is supernaturally constituted. Being convinced of the human condition, the good doctor knows that he himself, a patient of sorts, needs a Physician. He has, therefore, secured a most urgent relationship with the transcendent God. The epistemological dilemma --- "what is known in barrooms and school yards as 'the grand sez who'?" --- becomes at once impotent.(6) In that He imbued life with meaning, our doctor knows how he should live, and why anything makes sense. From his own dependency, with humility and compassion, he genuinely ministers to people. He relates to his patients from this antithetical(7) worldview, in a culture whose current enlightened posture renders it entirely implausible. His may be a solitary stance, but a mixture of fear and conviction compels him, lest he "be likened unto a foolish man, which built his house upon the sand: And the rain descended, and the floods came, and the winds blew, and beat upon that house; and it fell: and great was the fall of it." He has avoided resting his hammer on precarious philosophical ground, of which one wise monarch has concluded, "Meaningless. Meaningless. Everything is meaningless."
1. Adler MJ, Van Doren C. How to Read a Book. New York, NY Simon &
2. Allopathic medicine, strictly speaking (and ironically), is a healing model that attempts to cure disease by creating a second condition "antagonistic" to the initial problem. This is not the sense in which I use the term; I employ the popular, if not incorrect, notion of the traditional physician as the allopath. Almost all traditional medical schools produce "allopathic" practitioners. Non-allopathic practitioners would be homeopaths, naturopaths, iridologists, and so on.
3. Terrell H. Quakery. Journal of Biblical Ethics in Medicine 1994;8:17-20.
4. Alternative, or complementary, medicine is a broad term that encompasses most non-allopathic or non-traditional physicians. Homeopathy and acupuncture are examples of alternative medicine. In the main, its practitioners are not considered "real" doctors by many traditional standards. This trend, though, is changing. The reason for alternative medicine's increasing popularity is, in part, because traditional medicine is not without its own problems. In any case, both camps presumably claim to have the best doctors. Many are integrating the two systems, in the hope of some kind of superior hybrid. This approach has not, however, been without criticism.
5. Ross CA, Pam A. Pseudoscience in Biological Psychiatry: Blame it on the Brain. New York, NY, John Wiley & Sons, 1995.
6. By epistemology, I mean the theory of knowledge or how we can know anything. This field tries to answer the question "How can we be sure" or "How do we know." This is primarily a philosophical matter. In that all areas of knowledge make tacit philosophical assumptions, however, they are not immune to epistemological scrutiny. In traditional legal theory, for instance, this issue becomes even more acute, as laws propose fair and impartial rules (ideally) to constrain and govern the behavior of men. Hence, the question "sez who?" becomes an interesting, if not impudent, one. In similar manner, the question of the good doctor's identity, and how we are to characterize him, is open to the same challenge. This is what I imply by the notion of an "epistemological dilemma." Since Holy Writ, on its own testimony, claims to be true (i.e. canon), the resultant epistemology would necessarily escape this quandary, a quandary that is settled, literally, by divine fiat. In passing, I might note that this position is open to the charge of petitio principii, or begging the question, but that is a separate issue and beyond the scope of our discussion. The subsequent quote is from Leff AA. Unspeakable Ethics, Unnatural Law. Duke Law Journal 1979;1979:1229-1249.
7. Antithesis is the direct opposite of thesis. For example, truth is the antithesis of falsehood; black is the antithesis of white, and so on. In that sense, a good doctor's worldview is antithetical to the status quo, something that may be described as implicit scientism or metaphysical naturalism. If truth is always determined by popular opinion, this view is a bit ephemeral. Popular opinion can be unreliable however, as historical reflection might suggest, a reflection that has duly pondered Christopher Columbus - and his pedagogic ilk - who saved cartographers the embarrassment of drawing global maps having more in common with soccer turfs than the "globe" we now know.
Dr. Madueme is a resident in internal medicine at the Mayo Clinic in Rochester, Minnesota. His e-mail is firstname.lastname@example.org.
Originally published in the Medical Sentinel 2001;6(2):67-68.
Copyright©2001, Association of American Physicians and Surgeons