What happens to medicine when it has no heroes?

A few years ago, a medical journal piece about electronic medical records with built-in decision support announced that the days of super-physicians and master diagnosticians were over.

Being a doctor isn’t very glamorous anymore, and being a good one seems rather obsolete with so many guidelines and protocols telling us what to do.

A hundred years ago, William Osler, a practicing physician, had single-handedly written the leading textbook of medicine, reformed medical education, helped create and chaired Johns Hopkins and become the chair of medicine at Oxford.

Today, it is virtually necessary to be a researcher to teach at a university, let alone chair a medical school. The only other way to advance in medicine is to go into administration. Leaders in medicine are not chosen for their mastery of clinical practice, but for their managerial or business acumen.

The culture of clinical excellence has few heroes in our time. Pharmaceutical companies sometimes speak of “thought leaders” on the local level, which is more often than not only their way of building momentum for their drug sales through promoting early adoption of new medicines. Doctors today practice on a level playing field, where we are considered interchangeable providers in large organizations and insurance networks. Media doctors don’t earn their position based on clinical mastery, but rather their communication and self promotion skills.

What happens to medicine when it has no heroes? Who defends the ideals of a profession that is becoming commoditized? What keeps new physicians striving for clinical excellence with only numerical quality metrics and policy adherence as yardsticks? How are the deeper qualities of doctoring preserved for new generations of doctors, and how are they kept in focus with all the distractions of today’s health care environment — because people still worry and suffer; they are more than bodies with diseases or abnormal test results.

Every day, doctors on the front lines treat two dozen fellow human beings with every imaginable condition. How do we carry on, with only our own ideals as beacons in the fog, if we are left to ourself to defend our higher purpose, without champions, mentors, or heroes?

“A Country Doctor” is a family physician who blogs at A Country Doctor Writes:.

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  • Adr Born

    All that is left is to blog about the heroic times of the master clinicians of the past and perhaps give them a taste of what it was like in the hope that one day, such human skills may return. Perhaps there is a chance of explaining their mindset that gave them these abilities.

    This is the real humanity that is missing in medicine. These were not average humans but the pinnacle of what humanity could and should be.

    Their great heroism was in how they got there. They did it the hard way. It was through a life, a 24/7 life, of uncompromising selflesssness for their vocation in service to their patients’ health.

    I note in your most recent and as every eloquent blog that you describe yourself as not outgoing and never good at small talk in social situations. This is so characteristic of every master of the clinical arts that I was privileged to call teacher. It is a part of their detached compassion from selflessness that is rarely discussed outside traditional Buddhism but practiced by monks and sages of all religions. They lived mindlessness from selflessness in their service of patients. It became their source of objectivity and intellect. Their inner silence allowed them to hear the quiet voice of clinical inspiration.

    These are some of the issues that I have started to address http://clinicalarts.blogspot.mx/2013/11/knowledge-is-food-of-clinical-intuition.html and will expand on…

    This is not something that can be turned on and off. It must be lived fulltime. How is that possible in a modern egocentric world? How is it possible with the external pressures that are placed on doctors these days? Pay you here for ticking a thousand boxes. Abuse and disrespect you there.

    When administrators override clinical decisions or decide to time limit consultations, it is physician abuse. The belief that machines and protocols should be the master of the human clinician for medicolegal reasons is total disrespect of the potential of the human clinician.

    Can it be done in a society that considers sympathy compassion and pressures doctors to come down to their level and share in their emotions rather than remaining detached and objective?

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