The title of Dr. Samuel LeBaron’s article is intriguing enough. The fact that the author quotes three separate poems in a journal called Academic Medicine makes it even more alluring.
LeBaron’s focus is the restoration of balance.
[W]e have lost a healthy, and necessary, balance in the learning and professing of medicine between knowledge (science) and wisdom (humanism) and have become a group of professionals who are brilliant and relentless in memorizing and understanding complex facts, but who flounder in our application of those facts with living human beings. Patients, LeBaron writes,
are already insisting on this balance of knowledge and wisdom, even though they may not necessarily use those exact words.
LeBaron reiterates how important
scientific research and knowledge is to modern medicine. Diminishing science and its principles
would be foolish beyond words. If biomedical science, though, were enough for a physician to heal, we would be living in an ever-more perfect, golden age of medicine. Most would agree that’s not quite the case.
Science and humanities are usually seen as opposites. The really wonderful thing I think LeBaron adds to the discussion of their roles in medicine is the idea of messiness.
Science has its own kind of messiness. Scientific progress is rarely a straight line. The scientific method may come up with more questions before it comes up with good answers. The success of science and falsifiable fact-checking, though, is that—eventually—it will come up with an answer, or at least a better one.
We as human beings don’t work this way. LeBaron’s article is intensely intimate and personal. The author wrestles with self-doubt and a lack of compassion, as well as frustrating, confounding, and demanding patients. LeBaron also shares an emotional story of simply being present at the end of a young cancer patient’s life. What the healing professional and the patient share is this humanity, this kind of messiness.
Humanism is imbedded in human interaction and encompasses all aspects of life, including the most deeply satisfying and meaningful of experiences, and at other times, moments that are confusing and difficult to the point of despair. The willingness to accept this wide range of experience is the measure of one’s readiness to engage in relationships that are meaningful and worthwhile, no matter how difficult they may be.
Such physicians value a path that is shared with the patient, even though that path becomes both more unpredictable and more difficult at times. This path requires the physician to pay attention and respond thoughtfully to questions, wishes, and fears of the patient.
Science is indispensable because it is
a powerful lens through which we can learn much about illness. But medicine and healing
is equally about life stories and caring for people who suffer.
As much as science has a messy process, we as human beings should acknowledge our own messiness. Speaking of childhood, LeBaron remembers that
wild beasts … roamed across my inner landscape. Although certainly more in control of emotion now as an adult, LeBaron talks of those internal wild beasts still being present. All of us are capable of unleashing those inhuman “dragons” on one another.
Compassion and coping with difficulties is not some mathematical or scientific ideal that can be reached:
While growing up, the presence of these inner dragons seemed incompatible with my image of a compassionate being, although my ideas on this matter were quite fuzzy. For me, the idea of compassion had developed as something both theoretical and theological, mostly in the iconic realm of a shining golden Buddha or Jesus, rather than anything that could actually exist here and now, in the real lives of real people. Perhaps this view was fueled by a fundamental misunderstanding. I imagined that compassion was just like how the statues of the Buddha and Jesus looked: saintly, never angry or anxious at all hours of day or night, rain or shine. In short, compassion appeared to be an unrealistic and unattainable goal for me, in view of my very human quirks and shortcomings.
I wondered: Why bother anyway?
Our shared humanity means that we are unpredictable. This is something that every person, especially healthcare professionals, will have to face. Scientific knowledge is essential, but so is our human understanding of one another. Only that wisdom can prepare us for the messiness of expecting the unexpected.
The more mature view of compassion as a living process is that compassion welcomes and provides sanctuary for all that is unpredictable, imperfect, incomplete, awkward, pinched, and unspoken. Therefore, compassionate doctors find themselves unexpectedly and awkwardly, without any way to prepare or compose themselves, on the edge of life and death, almost falling off, faced with suffering that has no scientific remedy. In such a landscape, science loses its bearings; our compass doesn’t work; none of our familiar maps or signposts point the way. At best, we can only hope that our patients will guide us…
I find this idea of a living process with the patient as a guide profound. We as patients come to healers because the healer has a knowledge we don’t. As much as we depend on the healer to be a guide to the pathology and illness, the healer depends on us, the sick, to be a kind of guide at the point where scientific knowledge ends.
The article reviewed: LeBaron, Samuel. “Can the Future of Medicine Be Saved from the Success of Science?” Academic Medicine: Journal of the Association of American Medical Colleges 79, no. 7 (July 2004): 661–65.
Featured Image: cropped from Human Blood Samples, by Wikimedia user GrahamColm under a CC BY-SA 3.0 license