Dr. Jeff Kane: A little medical history
Our health-care system treats our bodies effectively, but sadly lacks in treating our suffering, the emotions that universally accompany illness. A look at our history will explain why this is so.
My first week in medical school, I and every other future American doc learned that today’s healthcare style began with the Flexner Report. Early in the 20th century, industrialists Andrew Carnegie and John D. Rockefeller determined to convert America’s horse-and-buggy medicine into a sleek modern vehicle. They commissioned respected educator Abraham Flexner to survey the entire national medical education system.
Flexner visited every school, and in 1910 reported that the enterprises calling themselves medical schools ranged from universities to carnival booths, from legitimate to outright fraudulent. Flexner recommended that medical education be uniformly and rigorously scientific. Carnegie and Rockefeller responded by funding science-based departments around the country, and soon the unfunded schools went belly-up.
Support for this shift wasn’t universal. Among the critics was Dr. William Osler, who’s still revered as the patriarch of North American medicine. He warned that exclusive scientific focus would shrink docs into mere technicians. “The practice of medicine is an art, not a trade,” he taught his students. “It’s a calling, not a business; a calling in which your heart will be exercised equally with your head. Often the best part of your work will have nothing to do with powders or potions…”
Science prevailed, and Osler, disgusted, decamped to the U.K. Years later, though, Flexner agreed with him. In the 1920s he wrote, “… scientific medicine in America … is today sadly deficient in cultural and philosophic background. … The imposition of rigid standards by accrediting groups has made the medical curriculum a monstrosity, leaving medical students little time to stop, read, work or think.”
Indeed, today’s medical students don’t even have time to learn about Flexner’s change of heart.
Establishing science as medicine’s core wasn’t a bad thing to do. It’s benefited us hugely in lengthening life spans, eradicating smallpox and polio, employing antibiotics, and re-coding genes, among other miracles. But its successes have ironically revealed its limitations, too. The child whose life penicillin saved in 1945 is old now, and suffering a variety of chronic — that is, incurable — ailments.
We’re rich in high-tech interventions, but ill-equipped for many of today’s major challenges, such as altering pathogenic lifestyles, guiding the hurting aged, and comforting the sick and dying.
The first baby boomers turned 65 in 2011. Now they’re beginning to suffer the enduring infirmities of age.
To address this “silver tsunami” we’ll need to restore a proper balance between medicine’s science and, as Osler put it, its art.
Dr. Jeff Kane is a physician and writer in Nevada City.
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